Less dementia with oral anticoagulation in atrial fibrillation
Less dementia with oral anticoagulation in atrial fibrillation
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DOI：
10.1093/eurheartj/ehx579
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发表时间：
2018-02-07
影响因子：
39.3
通讯作者：
Rosenqvist, Marten
中科院分区：
文献类型：
--
作者：
Friberg, Leif;Rosenqvist, Marten
目的 心房颤动 (AF) 和痴呆之间的关联已有充分记录，但尚不清楚口服抗凝治疗是否能提供保护。因此，本研究的目的是比较使用和不使用口服抗凝剂的 AF 患者新发痴呆的发生率，并探讨新型抗凝剂和华法林在这方面是否存在差异。方法和结果对 2006 年至 2014 年间瑞典所有医院诊断为 AF 且既往未诊断出痴呆的患者进行回顾性登记研究。倾向评分匹配、伪造终点以及根据意向治疗和治疗目的进行分析。采用治疗原则。该研究包括 444,106 名患者和超过 150 万年的风险。与未接受抗凝治疗的患者相比，基线时接受抗凝治疗的患者痴呆风险降低 29% [风险比 (HR) 0.71，95% 置信区间 (95% CI) 0.68-0.74]，治疗分析风险降低 48%（HR 0.52，95% CI 0.50-055）。新型口服抗凝药与华法林的直接比较未见差异（HR 0.97，95% CI 0.67-1.40）。结论 房颤患者未经口服抗凝治疗，发生痴呆的风险较高。这表明房颤患者早期开始抗凝治疗对于保留认知功能可能有价值。
Aims The association between atrial fibrillation (AF) and dementia is well documented, but it is not clear if oral anticoagulant treatment offers protection. The aim of the study is therefore to compare the incidence of new dementia in patients with AF with and without oral anticoagulants, and to explore if there is a difference between novel anticoagulants and warfarin in this respect.Methods and results Retrospective registry study of all patients with hospital diagnosis of AF and no previous diagnosis of dementia in Sweden between 2006 and 2014. Propensity score matching, falsification endpoints, and analyses according to intention to treat as well as on-treatment principles were used. The study included 444 106 patients and over 1.5 million years at risk. Patients on anticoagulant treatment at baseline was associated with 29% lower risk of dementia than patients without anticoagulant treatment [hazard ratio (HR) 0.71, 95% confidence intervals (95% CI) 0.68-0.74] and 48% lower risk analysed on treatment (HR 0.52, 95% CI 0.50-055). Direct comparison between new oral anticoagulants and warfarin showed no difference (HR 0.97, 95% CI 0.67-1.40).Conclusion The risk of dementia is higher without oral anticoagulant treatment in patients with AF. This suggests that early initiation of anticoagulant treatment in patients with AF could be of value in order to preserve cognitive function.