Safety And Efficacy Of Warfarin In Patients With Non-valvular Atrial Fibrillation And Non-end-stage Chronic Kidney Disease:Meta-analysis

Objective:This study is intended to investigate the efficacy and safety of warfarin in patients with non-valvular atrial fibrillation(NVAF)and non-end-stage chronic kidney disease(CKD)through performing a meta analysis.Methods:We searched studies in electronic databases including Pubmed、Embase、Web of science 、 Cochrane library.All the randomized controlled trials and observational studies about the use of warfarin in patients with non-valvular atrial fibrillation and non-end stage chronic kidney disease were searched.The combined end point is ischemic stroke/systematic embolism,major bleeding and mortality.We conducted the meta-analysis of the data collected from the included studies with The Cochrane Collaboration`s review manager 5.2 software.Fixed or randomized potency model was chosen according to the heterogeneity.Estimated the evaluation index by 95% confidence interval and made α=0.05 for the size of test.Results:All 433 English literatures were searched.There were only 6 trials met a criterion were analyzed,involving 36914 patients with non-valvular atrial fibrillation and non-end stage chronic kidney disease.The patients were divided into the following two groups: Group 1(patients treated with adjusted-dose warfarin)and Group 2(patients treated with aspirin plus fixed-dose warfarin or other antiplatelet drugs).Group 1 had lower rate of all cause mortality(OR=0.70;95%CI 0.65-0.75,P<0.00001)and lower event of ischemic stroke/thromboembolism(OR=0.57;95%CI 0.41-0.79,P=0.0008)respectively when compared with group 2.The major bleeding events were not different between the two groups(OR=1.20;95%CI 0.98-1.46,P=0.08).Conclusion:Adjusted-dose warfarin is safe and effective in patients with non-valvular atrial fibrillation and non-end-stage chronic kidney disease.