Oral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: A population-based cohort study

© 2020 Heart Rhythm Society Background: Whether oral anticoagulation (OAC) can prevent dementia or cognitive impairment (CI) in patients with atrial fibrillation (AF) remains unclear. Objective: The purpose of this study was to investigate the risk of dementia/CI among AF patients with and without O...

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Main Authors: Pajaree Mongkhon, Laura Fanning, Wallis C.Y. Lau, Gary Tse, Kui Kai Lau, Li Wei, Chuenjid Kongkaew, Ian C.K. Wong
Format: Journal
Published: 2020
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/68547
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spelling th-cmuir.6653943832-685472020-04-02T15:29:16Z Oral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: A population-based cohort study Pajaree Mongkhon Laura Fanning Wallis C.Y. Lau Gary Tse Kui Kai Lau Li Wei Chuenjid Kongkaew Ian C.K. Wong Medicine © 2020 Heart Rhythm Society Background: Whether oral anticoagulation (OAC) can prevent dementia or cognitive impairment (CI) in patients with atrial fibrillation (AF) remains unclear. Objective: The purpose of this study was to investigate the risk of dementia/CI among AF patients with and without OAC treatment. Methods: We conducted a retrospective cohort study using United Kingdom (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 were receiving OAC treatment and 49,276 received no OAC treatment; of these patients, 29,282 were receiving antiplatelets. Over a mean follow-up of 5.9 years, 5295 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 0.85–0.95; P <.001) or antiplatelets (HR 0.84; 95% confidence interval 0.79–0.90; P <.001). No significant difference in dementia risk was observed for direct oral anticoagulants (DOACs) vs warfarin (HR 0.89; 95% confidence interval 0.70–1.14; P =.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% confidence interval 1.05–1.31; P =.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 on cognitive function is insufficient, and further studies including randomized clinical trials are warranted. 2020-04-02T15:29:16Z 2020-04-02T15:29:16Z 2020-01-01 Journal 15563871 15475271 2-s2.0-85080889063 10.1016/j.hrthm.2020.01.007 https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85080889063&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/68547
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Medicine
spellingShingle Medicine
Pajaree Mongkhon
Laura Fanning
Wallis C.Y. Lau
Gary Tse
Kui Kai Lau
Li Wei
Chuenjid Kongkaew
Ian C.K. Wong
Oral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: A population-based cohort study
description © 2020 Heart Rhythm Society Background: Whether oral anticoagulation (OAC) can prevent dementia or cognitive impairment (CI) in patients with atrial fibrillation (AF) remains unclear. Objective: The purpose of this study was to investigate the risk of dementia/CI among AF patients with and without OAC treatment. Methods: We conducted a retrospective cohort study using United Kingdom (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 were receiving OAC treatment and 49,276 received no OAC treatment; of these patients, 29,282 were receiving antiplatelets. Over a mean follow-up of 5.9 years, 5295 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 0.85–0.95; P <.001) or antiplatelets (HR 0.84; 95% confidence interval 0.79–0.90; P <.001). No significant difference in dementia risk was observed for direct oral anticoagulants (DOACs) vs warfarin (HR 0.89; 95% confidence interval 0.70–1.14; P =.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% confidence interval 1.05–1.31; P =.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 on cognitive function is insufficient, and further studies including randomized clinical trials are warranted.
format Journal
author Pajaree Mongkhon
Laura Fanning
Wallis C.Y. Lau
Gary Tse
Kui Kai Lau
Li Wei
Chuenjid Kongkaew
Ian C.K. Wong
author_facet Pajaree Mongkhon
Laura Fanning
Wallis C.Y. Lau
Gary Tse
Kui Kai Lau
Li Wei
Chuenjid Kongkaew
Ian C.K. Wong
author_sort Pajaree Mongkhon
title Oral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: A population-based cohort study
title_short Oral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: A population-based cohort study
title_full Oral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: A population-based cohort study
title_fullStr Oral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: A population-based cohort study
title_full_unstemmed Oral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: A population-based cohort study
title_sort oral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: a population-based cohort study
publishDate 2020
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85080889063&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/68547
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