Oral anticoagulants significantly reduced cognitive impairment compared to no treatment (HR 0.71; P<0.00001), and new oral anticoagulants were more protective than warfarin (HR 0.51; P<0.00001).
Meta-Analysis (n=471,057)
Does anticoagulant therapy reduce cognitive impairment in patients with atrial fibrillation?
Oral anticoagulants, particularly new oral anticoagulants, are associated with a significantly reduced risk of cognitive impairment in patients with atrial fibrillation.
Effect estimate: HR 0.71 (95% CI 0.69-0.74)
p-value: p=< 0.00001
BACKGROUND: At present, it is considered that atrial fibrillation (AF) is a risk factor for cognitive impairment and dementia. It is independent of stroke, but the relationship between anticoagulant drugs and cognitive function in patients with AF is unknown. OBJECTIVE: The purpose of this study was to complete a meta-analysis of studies and investigate the association between anticoagulant therapy and cognitive impairment in patients with AF. METHODS AND RESULTS: Two investigators systematically searched the Cochrane Library, PubMed, EMBASE databases, and Web of Science for all studies that present associations. Hazard ratios (HRs) were extracted and pooled. Finally, the 8 studies included 471,057 participants; time in therapeutic range (TTR) 75%; (HR 3.02, 95% CI 1.12-8.91; P = 0.03); TTR 25%-50% versus TTR >75% (HR 2.44, 95% CI 0.95-6.22; P = 0.06); TTR 50%-75% versus TTR >75% (HR 1.75, 95% CI 0.90-3.99; P = 0.1); oral anticoagulants (OAC) versus No OAC (HR 0.71, 95% CI 69-0.74; P < 0.00001); and new oral anticoagulants versus warfarin (HR 0.51, 95% CI 0.37-0.71; P < 0.00001). CONCLUSIONS: OACs significantly reduce the occurrence of cognitive impairment in patients with AF. Compared with warfarin, new oral anticoagulants have an efficiently protective effect on cognition. In the range of INR 2-3, with the increase of TTR, the incidence of cognitive impairment is lower.
Cheng et al. (Sun,) conducted a meta-analysis in Atrial fibrillation (n=471,057). Oral anticoagulants vs. No oral anticoagulants or warfarin was evaluated on Cognitive impairment (HR 0.71, 95% CI 0.69-0.74, p=< 0.00001). Oral anticoagulants significantly reduced cognitive impairment compared to no treatment (HR 0.71; P<0.00001), and new oral anticoagulants were more protective than warfarin (HR 0.51; P<0.00001).
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