Oral anticoagulants and risk of dementia: A systematic review and meta analysis of observational studies and randomized controlled trials

NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS

卷:96

Review

Mongkhon, Pajaree^1,2,3,4  Naser, Abdallah Y.⁵  Fanning, Laura⁶  Tse, Gary^7,8  Lau, Wallis C. Y.^3,9  Wong, Ian C. K.^3,9,10  Kongkaew, Chuenjid^1,3,11 

[1] Naresuan Univ, Fac Pharmaceut Sci, Dept Pharm Practice, Ctr Safety & Qual Hlth, Tha Pho, Mueang Phitsanu, Thailand

[2] Univ Phayao, Sch Pharmaceut Sci, Mae Ka, Phayao, Thailand

[3] UCL, Sch Pharm, Res Dept Practice & Policy, 29-39 Brunswick Sq, London WC1N 1AX, England

[4] Chiang Mai Univ, Pharmacoepidemiol & Stat Res Ctr PESRC, Fac Pharm, Chiang Mai, Thailand

[5] Al Isra Univ, Fac Pharm, Amman, Jordan

[6] Monash Univ, Eastern Hlth Clin Sch, Fac Med Nursing & Hlth Sci, Melbourne, Vic, Australia

[7] Chinese Univ Hong Kong, Fac Med, Dept Med & Therapeut, Hong Kong, Peoples R China

[8] Chinese Univ Hong Kong, Fac Med, Li Ka Shing Inst Hlth Sci, Hong Kong, Peoples R China

[9] Univ Hong Kong, Dept Pharmacol & Pharm, Ctr Safe Medicat Practice & Res, Hong Kong, Peoples R China

[10] Univ Coll London Hosp, CMORE, London, England

[11] Naresuan Univ, Fac Pharmaceut Sci, Ctr Excellence Environm Hlth & Toxicol, Phitsanulok, Thailand

关键词: Anticoagulant;    Direct oral anticoagulants;    Warfarin;    Atrial fibrillation;    Dementia;    Cognitive impairment;   

DOI  :  10.1016/j.neubiorev.2018.10.025

来源: Elsevier

【 摘 要 】

Atrial fibrillation (AF) is a documented risk factor for dementia. However, it is unclear whether oral anticoagulant (OAC) treatment can reduce the development of dementia or cognitive impairment. We conducted a systematic review and meta-analysis of the association between OAC use and subsequent dementia development in AF patients by searching databases from their inception to February 2018 without language restriction. Six studies (one randomized controlled trial and five observational studies) met the inclusion criteria. The pooled adjusted risk ratios (RRs) suggested a protective effect of OAC use in reducing dementia risk (RR 0.79 [95% CI: 0.67 - 0.93], I-2 = 59.7%; P = 0.005). Further, high percentage of time in therapeutic range (TTR) was associated with a decreased risk of dementia (RR 0.38 [95% CI 0.22-0.64], I-2 = 81.8%; P < 0.001). Our results support the hypothesis that AF-related dementia may be due to silent brain infarcts and micro-embolism that could be prevented by OAC use. Future studies with prospective follow-up with direct comparison of vitamin K antagonists and direct oral anticoagulants are needed.

【 授权许可】

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