Arrhythmias and Conduction DisturbancesMeta-Analysis of Anticoagulation Use, Stroke, Thromboembolism, Bleeding, and Mortality in Patients With Atrial Fibrillation on Dialysis
Section snippets
Methods
Full details of the methods are presented in the Appendix. In brief, we performed a systematic search of observational studies in MEDLINE and EMBASE databases up to June 2015. Eligible studies included patients with AF on dialysis reporting outcome data according to vitamin K antagonist use (either measures of relative risk [RR] for the association between anticoagulation use and outcomes) or incident event rates according to anticoagulation use. We sought to include patients on either
Results
The systematic search of electronic databases identified 1,884 studies, and an additional 6 studies were identified by manual searching of reference lists (Figure 1). From these, we identified 144 potentially relevant studies for full-text review. A total of 20 studies were subsequently included, involving 529,741 subjects and 31,321 patients with AF on dialysis (Table 1 and Supplementary Tables 1 and 2). Of the these studies, 17 reported or provided data on associations of anticoagulation
Discussion
In this systematic review and meta-analysis of 20 observational studies involving 31,321 patients with AF and end-stage renal disease on dialysis, we found unexpected associations of anticoagulation use with outcomes. Anticoagulation use was expectedly associated with increased hemorrhagic stroke, increased bleeding, and lower risk of any thromboembolism. In contrast, there were unfavorable or nonsignificant associations of anticoagulation use with any stroke, ischemic stroke, cardiovascular
Disclosures
The authors have no conflicts of interest to disclose.
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Drs. Wong, Odutayo, and Emdin are supported by Rhodes Scholarships. Dr Wong is also supported by a Neil Hamilton Fairley Fellowship from the National Health and Medical Research Council of Australia. Dr Sun is supported by an Australian Postgraduate Award from the University of Adelaide.