Afib: oral anticoagulant use tied to lower risk for dementia

  • Mongkhon P & al.
  • Heart Rhythm
  • 10 Jan 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with atrial fibrillation (Afib), the use of oral anticoagulants (OACs) was associated with a lower risk for dementia/cognitive impairment (CI) compared with non-OACs and antiplatelet use.

Why this matters

  • Current evidence is insufficient to determine whether direct OAC (DOACs) treatment offers a neuroprotective effect on cognition in patients with Afib and findings warrant further studies including randomised clinical trials.

Study design

  • Retrospective cohort study included 84,521 patients with newly diagnosed Afib using data from The Health Improvement Network (THIN) database.
  • Main outcome: composite of new-onset dementia/CI.
  • Funding: University of Hong Kong Seed Fund and others.

Key results

  • Of 84,521 patients with Afib, 35,245 received OAC treatment, 49,276 received no OAC treatment, and of these, 29,282 patients received antiplatelet treatment.
  • Over a mean follow-up of 5.9 years, incidence rates of dementia/CI were lower in the OAC vs non-OAC group (12.1 vs 13.3 per 1000 person-years).
  • OAC group had a lower risk for dementia/CI compared with non-OAC (HR, 0.90; 95% CI, 0.85-0.95; P<.001 and antiplatelet ci p group.>
  • No significant difference was observed in dementia risk between DOACs vs warfarin (HR, 0.89; 95% CI, 0.70-1.14; P=.373) group.
  • Dual therapy (OAC plus antiplatelet agent) linked with a higher risk for dementia/CI compared with no treatment (HR, 1.17; 95% CI, 1.05-1.31; P=.006).

Limitations

  • Retrospective design.
  • Risk of residual confounding.