Does Warfarin Use In AFib Increase Stroke Risk?

While anticoagulation with warfarin does not affect the incidence of ischemic stroke in patients with atrial fibrillation (AF) who are on dialysis, it does significantly increase the risk for hemorrhagic stroke and major bleeding, according to a new analysis. 

The analysis, which was co-authored by Mandeep Singh Randhawa, MD, was presented at the American College of Cardiology’s Annual Scientific Session & Expo.

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By analyzing 19 studies with a total of 70,331 participants with AF who were on dialysis, the researchers determined the risks and benefits of warfarin for anticoagulation. To do this, the incidence of stroke, major bleeding, and mortality were compared among those who were taking an anticoagulant and among those who were not taking an anticoagulant.

Of all the participants, 25% were taking warfarin. 

By assessing the average follow-up period of 2.3 ± 1.3 years, the researchers deemed there to be no significant change in the overall risk for any strokes, as well as no difference in risk for ischemic stroke or overall mortality. However, the researchers did determine that there was a significantly higher risk for both hemorrhagic stroke and major bleeding among participants taking warfarin.

—Colleen Murphy

Reference:

Singh Randhawa M, Vishwanath R, Rai MP, Randhawa AK, Wang L, Dhar G. Role of warfarin in patients with atrial fibrillation on dialysis: meta-analysis. Paper presented at: American College of Cardiology 68th Annual Scientific Session and Expo; March 16-18, 2019; New Orleans, LA. http://www.onlinejacc.org/content/73/9_Supplement_1/440. Accessed March 26, 2019.