In spite of the substantial burden of
atrial fibrillation and associated elevated
ischemic stroke risk in patients undergoing
hemodialysis, the role of
warfarin in these high-risk patients remains uncertain. Our objective was to clarify the association between
warfarin use and risk of
stroke for patients with
atrial fibrillation undergoing dialysis.PubMed and Embase from January 1966 to January 2015 were searched to identify relevant studies. Inclusion criteria were cohort studies, patients with
atrial fibrillation undergoing
hemodialysis, and reported quantitative estimates of the multivariate adjusted relative risk (RR) and 95% confidence interval (CI) for future
stroke associated with
warfarin use. We identified 8 studies, with a total of 9539 participants and 706
stroke events. Three studies reported total
stroke as primary endpoint and other studies reported
ischemic stroke as primary endpoint. Pooling the results showed that
warfarin use was associated with higher risk of any
stroke (RR 1.50, 95% CI: 1.13-1.99). By
stroke type,
warfarin was not significantly linked to risk of
ischemic stroke (RR 1.01, 95% CI: 0.65-1.57, Pā=ā0.97), but was related to greater
hemorrhagic stroke risk (RR 2.30, 95% CI: 1.62-3.27).
Warfarin heightened overall
bleeding risk (RR 1.27, 95% CI: 1.03-1.56), but not death (RR 0.67, 95% CI: 0.37-1.21).Among patients with
atrial fibrillation undergoing
hemodialysis, use of
warfarin is associated with a higher risk of
hemorrhagic stroke, but did not increase overall mortality.