医学
痴呆
心房颤动
危险系数
内科学
置信区间
队列研究
比例危险模型
队列
回顾性队列研究
人口
低风险
倾向得分匹配
华法林
冲程(发动机)
疾病
工程类
环境卫生
机械工程
作者
Pajaree Mongkhon,Laura Fanning,Wallis C.Y. Lau,Gary Tse,Kui Kai Lau,Li Wei,Chuenjid Kongkaew,Ian Chi Kei Wong
出处
期刊:Heart Rhythm
[Elsevier]
日期:2020-05-01
卷期号:17 (5): 706-713
被引量:58
标识
DOI:10.1016/j.hrthm.2020.01.007
摘要
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. Whether oral anticoagulation (OAC) can prevent dementia or cognitive impairment (CI) in patients with atrial fibrillation (AF) remains unclear. The purpose of this study was to investigate the risk of dementia/CI among AF patients with and without OAC treatment. 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. 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). 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.
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