Warfarin Increases Hemorrhagic Stroke Risk in Patients With AF Undergoing Dialysis

Warfarin, blood thinner
Warfarin, blood thinner
Warfarin has been linked to major bleeding and hemorrhagic stroke risk in patients with atrial fibrillation who are undergoing dialysis.

In a meta-analysis of patients with atrial fibrillation on dialysis, warfarin use was associated with a significant (49%) increased risk for hemorrhagic stroke.

Warfarin anticoagulation is associated with a higher risk for hemorrhagic stroke and major bleeding in patients with atrial fibrillation (AF) on dialysis, but the treatment had no effect on ischemic stroke or mortality, according to the findings of a meta-analysis presented at the American College of Cardiology’s 68th Annual Scientific Session & Expo, held March 16-18 in New Orleans, Louisiana,  and published in the Journal of the American College of Cardiology.

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The meta-analysis, conducted by Mandeep Singh Randhawa, MD, and colleagues at Michigan State University in East Lansing, included 19 studies with a total of 70,331 patients with AF who were undergoing dialysis. Of these patients, 25% were on warfarin.

During an average follow-up period of 2.3 years, warfarin users experienced a significant (49%) increased risk for hemorrhagic stroke (hazard ratio [HR], 1.49; 95% CI, 1.03-1.94) and a 68% increased risk for major bleeding (HR, 1.68; 95% CI, 1.02-2.35), Dr Randhawa’s team reported. Results showed no significant difference between warfarin users and non-users with regard to ischemic stroke and overall mortality.


Randhawa MS, Vishwanath R, Rai MP, Randhawa AK, Wang L, Dhar G. Role of warfarin in patients with atrial fibrillation on dialysis: meta-analysis. Presented at: American College of Cardiology 68th Annual Scientific Session & Expo; March 16-18, 2019; New Orleans, LA. Abstract 1220-287.