Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(8), 866–876. https://doi.org/10.1002/clc.24076 Dr. Wenjie Wang et al.
Points
- Atrial fibrillation (AF) patients face an increased risk of dementia, and the study aimed to explore the relationship between oral anticoagulants (OACs) and dementia risk in these individuals.
- Analysis of 14 research studies involving 910 patients indicated that OACs were associated with a reduced risk of dementia, with a pooled hazard ratio (HR) of 0.68 and a 95% confidence interval (CI) of 0.55–0.82.
- Nonvitamin K antagonist oral anticoagulants (NOACs) were found to be more effective in reducing dementia risk than vitamin K antagonists (VKAs), with a pooled HR of 0.87 and a 95% CI of 0.79–0.95, especially in AF patients with a CHA2DS2VASc score of 2 or higher.
- Subgroup analyses showed no significant differences in dementia risk among AF patients under 65, those participating in “based on treatment” studies, or those without a history of stroke.
- The study emphasizes the need for further prospective research to validate these findings, particularly in patients involved in “based on treatment” studies, those under 65 years of age, and those with a CHA2DS2VASc score of less than two or no prior history of stroke.
Summary
In a comprehensive study conducted until July 1, 2022, researchers explored the association between oral anticoagulants (OACs) and the risk of dementia in patients with atrial fibrillation (AF). A total of 14 research studies encompassing 910 patients were analyzed in this investigation. The primary hypothesis was that OACs might reduce the incidence of dementia in AF patients, focusing on comparing nonvitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs).
The findings, as reported in the paper, revealed a significant correlation between OAC use and a reduced risk of dementia (pooled hazard ratio [HR]: 0.68, 95% confidence interval [CI]: 0.55–0.82), albeit with substantial heterogeneity (I2 = 87.7%). Furthermore, NOACs exhibited a stronger protective effect against dementia when compared to VKAs (pooled HR: 0.87, 95% CI: 0.79–0.95, I2 = 72%), especially in individuals with a CHA2DS2VASc score of 2 or higher (pooled HR: 0.85, 95% CI: 0.72–0.99).
Subgroup analyses, as outlined in the research, yielded no statistically significant differences among patients under 65 years of age (pooled HR: 0.83, 95% CI: 0.64–1.07), patients involved in “based on treatment” studies (pooled HR: 0.89, 95% CI: 0.75–1.06), or individuals without a prior history of stroke (pooled HR: 0.90, 95% CI: 0.71–1.15).
Consequently, this analysis underscores the potential benefits of OACs in reducing the incidence of dementia among AF patients. It suggests that NOACs may offer superior protection to VKAs, particularly in individuals with a CHA2DS2VASc score of 2 or higher. However, the study emphasizes the need for further prospective research to validate these findings, with specific attention to patients involved in “based on treatment” studies, those under 65 years of age, and those with a CHA2DS2VASc score less than two or no prior history of stroke.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24076
References Wang, W., Fan, W., Su, Y., & Hong, K. (2023). A comparison of the effects of NOAC and VKA therapy on the incidence of dementia in patients with atrial fibrillation: A systematic review and meta‐analysis. Clinical Cardiology, 46(8), 866–876. https://doi.org/10.1002/clc.24076
