Pajaree Mongkhon1, Laura Fanning2, Wallis C Y Lau3, Gary Tse4, Kui Kai Lau5, Li Wei6, Chuenjid Kongkaew7, Ian C K Wong8. 1. Centre for Safety and Quality in Health, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom. 2. Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom; Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. 3. Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Neurological and Mental Health Global Epidemiology Network (NeuroGEN). Electronic address: wallis.lau@ucl.ac.uk. 4. Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China. 5. Neurological and Mental Health Global Epidemiology Network (NeuroGEN); Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong. 6. Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom; Neurological and Mental Health Global Epidemiology Network (NeuroGEN); Centre for Medication Optimisation Research and Education (CMORE), University College London Hospital, London, United Kingdom. 7. Centre for Safety and Quality in Health, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom. 8. Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Neurological and Mental Health Global Epidemiology Network (NeuroGEN); Centre for Medication Optimisation Research and Education (CMORE), University College London Hospital, London, United Kingdom. Electronic address: wongick@hku.hk.
Abstract
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.
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 AFpatients 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 AFpatients. The evidence for DOAC on cognitive function is insufficient, and further studies including randomized clinical trials are warranted.
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