Oral Anticoagulant and Reduced Risk of Dementia in Patients with Atrial Fibrillation: A Population-Based Cohort Study
Abstract
BACKGROUND
It remains unclear whether oral anticoagulation (OAC) can prevent dementia or cognitive impairment (CI) in patients with atrial fibrillation (AF).
OBJECTIVE
To investigate the risk of dementia/CI among AF patients with and without OAC treatment.
METHODS
We conducted a retrospective cohort study using UK primary care data (2000-2017). Participants with newly diagnosed AF without a history of dementia/CI were identified. Inverse probability of treatment weights based on propensity-scores and Cox regression were used to compare the dementia outcomes.
RESULTS
Among 84,521 patients with AF, 35,245 patients were on OAC treatment, 49,276 received no OAC treatment and of these, 29,282 patients were on antiplatelets. Over a mean follow-up of 5.9 years, 5,295 patients developed dementia/CI. OAC treatment was associated with a lower risk of dementia/CI compared to no OAC treatment (hazard ratio (HR) 0.90, 95% confidence interval (CI), 0.85-0.95, p<0.001) or antiplatelets (HR=0.84, 95% CI=0.79-0.90, p<0.001). No significant difference in dementia risk was observed for direct oral anticoagulants (DOACs) versus warfarin (HR 0.89, 95% CI, 0.70-1.14, p=0.373), whereas dual therapy (OAC plus an antiplatelet agent) was associated with a higher risk of dementia/CI compared with no treatment (HR 1.17, 95% CI, 1.05-1.31), p=0.006).
CONCLUSION
OAC use was associated with a lower risk of dementia/CI compared to non-OAC and antiplatelet treatment among AF patients. The evidence for DOAC…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 84,521 participants or records.
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