Warfarin use and the risks of stroke and bleeding in hemodialysis patients with atrial fibrillation: A systematic review and a meta-analysis

Nutr Metab Cardiovasc Dis. 2015 Aug;25(8):706-13. doi: 10.1016/j.numecd.2015.03.013. Epub 2015 Apr 1.


Background and aim: The efficacy and safety of warfarin therapy in hemodialysis (HD) patients with atrial fibrillation (AF) remains controversial. Thus, we performed, up to date, the first meta-analysis on the risks of stroke and bleeding in warfarin treatment in these populations.

Methods and results: The relevant literature was searched using the following electronic databases without any language restrictions: the Cochrane Library Database, PubMed, ISI, Ovid, and Chinese Biomedical Database from the establishment of the database to October 2014. The studies were included if (a) studies described the risk of stroke or bleeding with or without warfarin in dialysis patients with AF, (b) studies provided information about hazard ratio (HR) and 95% confidence interval (CI) of stroke or bleeding, and (c) the study design was a clinical cohort. The inverse variance method was used to obtain overall HRs and 95% CIs. Sensitivity analyses and publication bias were also performed. We identified six eligible studies with a total of 9816 patients. Combined HRs showed that warfarin cannot prevent strokes in HD patients with AF (HR = 1.23, 95% CI 0.80-1.87; P = 0.347), but its use was associated with a higher risk of bleeding (HR = 1.20, 95% CI 1.03-1.39; P = 0.019).

Conclusion: This meta-analysis suggested that warfarin should not be recommended for the routine treatment of HD patients with AF.

Keywords: Atrial fibrillation; Bleeding; Hemodialysis; Stroke; Warfarin.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use
  • Atrial Fibrillation / complications*
  • Hemorrhage / chemically induced*
  • Hemorrhage / epidemiology
  • Humans
  • Renal Dialysis*
  • Risk Factors
  • Stroke / epidemiology
  • Stroke / etiology
  • Stroke / prevention & control*
  • Warfarin / administration & dosage
  • Warfarin / adverse effects*
  • Warfarin / therapeutic use*


  • Anticoagulants
  • Warfarin