Oral Anticoagulant Treatment and the Risk of Dementia in Patients With Atrial Fibrillation: A Population‐Based Cohort Study

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Edward Garrahy¹  Jan Radford¹  Woldesellassie M. Bezabhe²  Ivan Bindoff²  Gregory M. Peterson²  Mohammed S. Salahudeen²  Luke R. Bereznicki²  Barbara C. Wimmer² 

[1] Launceston Clinical School Tasmanian School of Medicine University of Tasmania Launceston Tasmania Australia;School of Pharmacy and Pharmacology University of Tasmania Hobart Tasmania Australia;

关键词: atrial fibrillation;    dementia;    direct‐acting oral anticoagulants;    oral anticoagulants;    warfarin;   

DOI  :  10.1161/JAHA.121.023098

来源: DOAJ

【 摘 要 】

Background We compared the dementia incidence rate between users and nonusers of oral anticoagulants (OACs) in a large cohort of primary care patients with atrial fibrillation. Methods and Results We performed a retrospective study using an Australia‐wide primary care data set, MedicineInsight. Patients aged ≥18 years and newly diagnosed with atrial fibrillation between January 1, 2010, and December 31, 2017, and with no recorded history of dementia or stroke were included and followed until December 31, 2018. We applied a propensity score for 1:1 pair matching of baseline covariates and Cox regression for comparing the dementia incidence rates for OAC users and nonusers. Data were analyzed for 18 813 patients with atrial fibrillation (aged 71.9±12.6 years, 47.1% women); 11 419 had a recorded OAC prescription for at least 80% of their follow‐up time. During the mean follow‐up time of 3.7±2.0 years, 425 patients (2.3%; 95% CI, 2.1%–2.5%) had a documented diagnosis of dementia. After propensity matching, the incidence of dementia was significantly lower in OAC users (hazard ratio [HR], 0.59; 95% CI, 0.44–0.80; P<0.001) compared with nonusers. Direct‐acting oral anticoagulant users had a lower incidence of dementia than non‐OAC users (HR, 0.49; 95% CI, 0.33–0.73; P<0.001) or warfarin users (HR, 0.46; 95% CI, 0.28–0.74; P=0.002). No significant difference was seen between warfarin users and non‐OAC users (HR, 1.08; 95% CI, 0.70–1.70; P=0.723). Conclusions In patients with atrial fibrillation, direct‐acting oral anticoagulant use may result in a lower incidence of dementia compared with treatment with either warfarin or no anticoagulant.

【 授权许可】

Unknown