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

TitleOral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: A population-based cohort study
Authors
KeywordsAtrial fibrillation
Cognitive impairment
Dementia
Oral anticoagulant
Vascular dementia
Issue Date2020
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/heartrhythmjournal
Citation
Heart Rhythm, 2020, v. 17, p. 706-713 How to Cite?
AbstractBackground: 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.
Persistent Identifierhttp://hdl.handle.net/10722/284984
ISSN
2019 Impact Factor: 5.731
2015 SCImago Journal Rankings: 2.756

 

DC FieldValueLanguage
dc.contributor.authorMongkhon, P-
dc.contributor.authorFanning, L-
dc.contributor.authorLau, WCY-
dc.contributor.authorTse, G-
dc.contributor.authorLau, KK-
dc.contributor.authorWei, L-
dc.contributor.authorKongkaew, C-
dc.contributor.authorWong, ICK-
dc.date.accessioned2020-08-07T09:05:12Z-
dc.date.available2020-08-07T09:05:12Z-
dc.date.issued2020-
dc.identifier.citationHeart Rhythm, 2020, v. 17, p. 706-713-
dc.identifier.issn1547-5271-
dc.identifier.urihttp://hdl.handle.net/10722/284984-
dc.description.abstractBackground: 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.-
dc.languageeng-
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/heartrhythmjournal-
dc.relation.ispartofHeart Rhythm-
dc.subjectAtrial fibrillation-
dc.subjectCognitive impairment-
dc.subjectDementia-
dc.subjectOral anticoagulant-
dc.subjectVascular dementia-
dc.titleOral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: A population-based cohort study-
dc.typeArticle-
dc.identifier.emailLau, WCY: wallisy@hku.hk-
dc.identifier.emailLau, KK: gkklau@hku.hk-
dc.identifier.emailWong, ICK: wongick@hku.hk-
dc.identifier.authorityLau, KK=rp01499-
dc.identifier.authorityWong, ICK=rp01480-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.hrthm.2020.01.007-
dc.identifier.pmid31931172-
dc.identifier.scopuseid_2-s2.0-85080889063-
dc.identifier.hkuros311786-
dc.identifier.volume17-
dc.identifier.spage706-
dc.identifier.epage713-
dc.publisher.placeUnited States-

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