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Warfarin use increases bleeding risk in hemodialysis patients with atrial fibrillation: A meta‐analysis of cohort studies
Author(s) -
Hussain Salman,
Siddiqui Ali Nasir,
Baxi Harveen,
Habib Anwar,
Hussain Md Sarfaraj,
Najmi Abul Kalam
Publication year - 2019
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14601
Subject(s) - medicine , warfarin , atrial fibrillation , meta analysis , relative risk , subgroup analysis , stroke (engine) , cohort study , anticoagulant , surgery , confidence interval , mechanical engineering , engineering
Background and Aim Atrial fibrillation is one of the most common comorbid conditions in hemodialysis patients, and warfarin is widely prescribed anticoagulant to prevent thromboembolic complications in such patients. In the last decade, several epidemiological studies pointed out the risk of bleeding with the use of warfarin. So, this meta‐analysis is aimed to assess the bleeding risk associated with the use of warfarin. Methods This meta‐analysis was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta‐analysis guidelines. PubMed, Embase, Scopus, and Cochrane central databases were searched from inception to June 10, 2018. The primary outcome was to quantify the bleeding risk associated with warfarin use. The secondary outcome was to assess the bleeding risk based on different subgroups. Review Manager (RevMan) version 5.3 was used for performing statistical analysis. Results A total of 15 studies, constituting a pooled sample of 53 581 patients (37.14% female), were included. Of these, 17 469 were warfarin users. We found that warfarin use had a significant association with the bleeding risk. The pooled relative risk (RR) of bleeding was estimated to be 1.35 (95% CI: 1.18–1.53, P = < 0.00001), and the pooled RR of major bleeding (five studies) was estimated to be 1.32 (95% CI: 1.07–1.63, P = 0.009). Subgroup analysis revealed a significant association of warfarin use with the intracranial hemorrhage/hemorrhagic stroke (nine studies) (pooled RR: 1.43 [95% CI: 1.20–1.71, P = < 0.0001]). Conclusions The results indicate that warfarin use increases the risk of bleeding in hemodialysis patients with atrial fibrillation.