Clinical InvestigationVitamin K antagonists for stroke prevention in hemodialysis patients with atrial fibrillation: A systematic review and meta-analysis
Section snippets
Search strategy and study selection
A search was performed in PubMed, EMBASE, and the Cochrane Library Database from inception to December 2015. Guidelines from scientific committees (American Heart Association/American College of Cardiology, Kidney Disease Improving Global Outcomes, Kidney Disease Outcomes Quality Initiative, Canadian Cardiovascular Society, European Society of Cardiology) and reference lists of identified articles were also reviewed. The list of titles and abstracts was assessed by 2 investigators to identify
Search results
The literature search identified 233 potentially relevant reports. Of these, 210 were excluded based on title and abstract review (Figure 1). After full review, 11 further reports were excluded: 4 for incomplete data, 1 for absence of stroke characterization, 2 for unavailability of outcome data on the hemodialysis subgroup, and 3 for prescription of VKA for other indications than AF. The study by Olesen et al21 was excluded for a complete overlap of the study population (Danish National
Discussion
In the past few years, the use of VKA in hemodialysis patients with AF has been the subject of an unresolved debate. The primary aim of this systematic review and meta-analysis was to evaluate whether VKA protect hemodialysis patients with AF against ischemic stroke and systemic embolism.
A first and important strength of our study is that we exclusively incorporated data obtained in hemodialysis patients. Thrice weekly anticoagulation during hemodialysis may protect against stroke. Patients
Acknowledgements
We are greatly indebted to Anders Nissen Bonde (MB, Copenhagen University Hospital Gentofte, Denmark), Lina Benson and Leif Friberg (PhD, MD, Karolinska Institutet and Cardiology Clinic, Stockholm, Sweden), Hoang Lai (MD, New York Medical College, Valhalla, NY), Louise Pilote (MD, MPH, PhD, McGill University Health Centre, Quebec, Canada), and Tom Wang (MBChB, Auckland City Hospital, New Zealand) for providing us with unpublished data on the hemodialysis subgroup of their study.
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Conflict of interest statement: The results presented in this paper have not been published previously in whole or part.