Impact of anticoagulation therapy on the cognitive decline and dementia in patients with non-valvular atrial fibrillation (cognitive decline and dementia in patients with non-valvular atrial fibrillation [CAF] trial).
Impact of anticoagulation therapy on the cognitive decline and dementia in patients with non-valvular atrial fibrillation (cognitive decline and dementia in patients with non-valvular atrial fibrillation [CAF] trial).
复制标题
DOI：
10.1002/joa3.12781
复制
发表时间：
2022-12
影响因子：
2
通讯作者：
Anderson, Jeffrey L
中科院分区：
文献类型：
--
作者：
Bunch, Thomas Jared;May, Heidi;Cutler, Michael;Woller, Scott C;Jacobs, Victoria;Stevens, Scott M;Carlquist, John;Knowlton, Kirk U;Muhlestein, Joseph B;Steinberg, Benjamin A;Anderson, Jeffrey L
房颤（AF）与认知障碍和痴呆的风险相关，这在有临床卒中史的患者中更为明显。观察性试验中抗凝剂的使用和疗效影响AF患者痴呆的长期风险。非瓣膜性房颤（CAF）患者的认知功能下降和痴呆试验是一项随机、前瞻性、开放标签、先锋临床研究，设盲终点评估，涉及中高危（CHADS 2或CHA2DS 2-Vasc评分≥ 2）非瓣膜性房颤患者，分配至达比加群酯或华法林组。主要终点是24个月时发生痴呆或中度认知能力下降。共入组101例患者[平均年龄：73.7 ± 6.0岁，男性：54例（53.5%）]。两组之间既往卒中和卒中风险因素相似。华法林组研究期间的平均INR为2.41 ± 0.68。没有患者发生中风或痴呆。简易精神状态评估、Hachinski缺血量表、阿尔茨海默病评估量表的认知子量表、痴呆残疾评估、明尼苏达心力衰竭生活量表评估的生活质量改善和抗凝血治疗量表生活质量调查评分在基线时或2年内均无变化。生物标志物分析表明抗凝策略的疗效相似。使用达比加群和管理良好的华法林治疗与2年时卒中、认知能力下降和痴呆的风险相似，表明任一策略均可接受。这项Vanguard研究的结果不支持进行更大规模的正式把握度研究。使用达比加群和管理良好的华法林治疗与2年时卒中、认知能力下降和痴呆的风险相似，表明任一策略均可接受。
Atrial fibrillation (AF) is associated with a risk for cognitive impairment and dementia, which is more pronounced in patients with a history of clinical stroke. Anticoagulation use and efficacy impact long‐term risk of dementia in AF patients in observational trials. The cognitive decline and dementia in patients with non‐valvular atrial fibrillation (CAF) Trial was a randomized, prospective, open‐label vanguard clinical study with blinded endpoint assessment involving patients with moderate‐ to high‐risk (CHADS2 or CHA2DS2‐Vasc scores of ≥2) non‐valvular AF assigned to dabigatran etexilate or warfarin. The primary endpoint was incident dementia or moderate cognitive decline at 24 months. A total of 101 patients were enrolled [mean age:73.7 ± 6.0 years, male: 54(53.5%)]. Prior stroke and stroke risk factors were similar between groups. Average INR over the study was 2.41 ± 0.68 in the warfarin group. No patient experienced a stroke or developed dementia. Mini‐Mental Status Evaluation, Hachinski Ischemic scale, cognitive subscale of the Alzheimer's Disease Assessment Scale, Disability Assessment for Dementia, Quality of Life Improvement as assessed by Minnesota Living with Heart Failure Scale and the Anti‐Clot Treatment Scale Quality of Life Survey scores did not vary at baseline or change over 2 years. Biomarker analysis indicated a similar efficacy of anticoagulation strategies. Use of dabigatran and well‐managed warfarin therapy were associated with similar risks of stroke, cognitive decline, and dementia at 2 years, suggestive that either strategy is acceptable. The results of this Vanguard study did not support the pursuit of a larger formally powered study. Use of dabigatran and well‐managed warfarin therapy were associated with similar risks of stroke, cognitive decline, and dementia at 2 years, suggestive that either strategy is acceptable.