Efficacy of Oral Anticoagulants (Warfarin) in EndStage Renal Disease Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis

Author(s):

Al-Anoud Farraj Al Al-Shaikh, Abdullah Dakhel Al-Rashod, Dhafer Ali Al-Amri, Omar Mohammed Al-Ghamdi, Othman Mohammed Al-Shahrani, Fawzia Saeed Al-Asmari, Reem Rizqallah Al-Johani, Shoaa Khalid Al-Dhahri, Abdullah Mohammed Hakami and Wafaa Mohammed Alalyani

Background: Warfarin stays a commonly used anticoagulant in the setting of EndStage Renal Disease (ESRD) and Atrial Fibrillation (AF). Research has investigated the effectiveness of warfarin in preventing ischemic strokes in ESRD and AF. They found that no randomized clinical trials have tested the function of warfarin, and periodically performed meta-analyses provided irrelevant results. Aim: This work aims to determine the efficacy of oral anticoagulants (Warfarin) in End-Stage Renal Disease (ESRD) patients with Atrial Fibrillation (AF). Materials and Methods: A systematic search was performed over different medical databases to identify Internal Medicine studies, which studied the outcome of Patients receiving Warfarin versus Patients not receiving Warfarin of ESRD patients. Using the meta-analysis process, either with fixed or random-effects models, we conducted a meta-analysis on, the incidence of ischemic strokes, and incidence of hemorrhagic stroke (as primary outcomes), and incidence of major bleeding and mortality rate (as secondary outcomes). Results: Six studies were identified involving 48737 patients, 16255 patients receiving Warfarin, and 32482 patients not receiving Warfarin. The meta-analysis process revealed that all outcome measures (ischemic and hemorrhagic strokes, major bleeding, along with mortality rates), exhibited non-significant differences if Warfarin administered or not (p>0.05 respectively). Conclusion: To conclude, Warfarin use appears to have been associated with no change in the incidence of ischemic stroke in patients with atrial fibrillation and end-stage renal disease. However, from the studies reviewed, it does appear to be associated with a significantly higher risk of hemorrhagic stroke, with no significant difference in the risk of major bleeding, and with no change in mortality.