AF patients receiving oral anticoagulation have a lower risk of dementia
Less dementia with oral anticoagulation in atrial fibrillationLiterature - Friberg L & Rosenqvist M. - Eur Heart J 2017; published online ahead of print
- At baseline, 54.3% of patients did not receive OAC, 42.9% used warfarin, 0.04% received phenprocoumon, and 2.9% used a NOAC.
- The strongest predictors for dementia were age (HR per decade: 2.19; 95% CI: 2.16–2.22), Parkinson’s disease (HR: 2.46; 95% CI: 2.25–2.69), absence of OAC treatment (HR: 2.08; 95% CI: 1.73-2.53), and alcohol abuse (HR: 1.53; 95% CI: 1.41–1.66).
- The incidence rate of dementia in patients receiving OAC was lower compared with patients without OAC (1.14 vs. 1.78 per 100 PYAR; P< 0.001).
- Compared with patients who did not receive OAC, patients with OAC at baseline had fewer previous hospitalization with bleeding diagnoses (12.2% vs. 19.3%; P< 0.001), fewer intracranial bleedings (1.7% vs. 3.3%; P < 0.001), and fewer recurrent fall accidents (3.4% vs. 8.0%; P< 0.001).
- Propensity score matching showed that patients with OAC treatment had a 29% lower risk of dementia compared with patients not on OAC at baseline (HR: 0.71; 95% CI: 0.68–0.74).
- In an on-treatment analysis, excluding non-OAC patients who later received OAC and OAC patients covered less than 80% of the time at risk, OAC patients had a 48% lower risk of dementia compared with non-OAC patients (HR: 0.52; 95% CI: 0.50–0.55).
- When NOACs and warfarin were compared to no treatment, the risk of dementia was lower with NOAC (HR: 0.48; 95% CI: 0.40–0.58) compared with warfarin (HR: 0.62; 95% CI: 0.60–0.64). This finding was verified with an on-treatment analysis (NOAC HR: 0.30; 95% CI: 0.22–0.42 vs. VKA HR: 0.53; 95% CI: 0.50–0.56).
- Of note, the NOAC and the VKA group differed in several of the baseline characteristics. A direct comparison between NOACs and warfarin, after propensity score matching for the likelihood of either treatment, showed no difference regarding the risk of dementia (HR: 0.97; 95% CI: 0.67–1.40).
In a large retrospective cohort study, the risk of dementia was higher without oral anticoagulant treatment in patients with AF, compared with AF patients receiving oral anticoagulation. These results suggest that early initiation of anticoagulant treatment in patients with AF could contribute to preservation of cognitive function.