Key result
Oral anticoagulant treatment was associated with a lower risk of all-cause mortality (HR 0.79) compared to non-OAC treatment in atrial fibrillation patients with dementia.
Why the study?
The decision to prescribe oral anticoagulants for stroke prevention in patients with atrial fibrillation and dementia remains controversial.
Does oral anticoagulant therapy reduce all-cause mortality in patients with atrial fibrillation and dementia compared to non-OAC treatment?
Meta-Analysis (n=21,962)
Does oral anticoagulant therapy reduce all-cause mortality in patients with atrial fibrillation and dementia compared to non-OAC treatment?
In patients with atrial fibrillation and dementia, oral anticoagulant therapy is associated with a significant reduction in all-cause mortality without a significant increase in major bleeding.
Answers are grounded in this paper and cite their sources.
OAC may lower mortality in AF with dementia; leaves open stroke prevention effect pending RCTs.
Background: The management of atrial fibrillation (AF) with oral anticoagulants (OAC) is generally recommended to reduce the risk of stroke. However, the decision to prescribe these medications for patients with AF and dementia remains controversial. Methods: A systematic review and meta-analysis of retrospective cohort studies were conducted. The search encompassed PubMed, Cochrane Library, Web of Science, and Embase databases from inception until May 1st, 2023, with language limited to English. Eligible studies included comparisons between exposure to OAC vs. non-OAC in the AF population with dementia or cognitive impairment. Studies that compared the effects of direct oral anticoagulants (DOAC) and vitamin-K antagonists were also included. The primary outcome was all-cause mortality, and the secondary outcomes were ischemic stroke and major bleeding. This study was registered with PROSPERO (No. CRD42023420678). Results: = 21,962 patients) met the eligibility criteria and were included in this review. The follow-up duration ranged from 1 to 4 years. Meta-analysis demonstrated that OAC treatment was associated with a lower risk of all-cause mortality in AF patients with dementia with a hazard ratio (HR) of 0.79 and a 95% confidence interval (CI) ranging from 0.68 to 0.92, compared to non-OAC treatment. No statistical differences were observed in the risk of major bleeding (HR = 1.12, 95% CI: 0.88-1.42) or ischemic stroke (HR = 0.77, 95% CI: 0.58-1.00). Three studies reported comparisons between DOAC and warfarin; however, pooled analysis was not performed due to heterogeneity. Conclusion: The use of OACs in individuals diagnosed with both AF and dementia holds the potential to reduce all-cause mortality rates, thereby improving the overall clinical prognosis within this specific population. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023420678, PROSPERO identifier, CRD42023420678.
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Wang et al. (2023) conducted a meta-analysis in Atrial fibrillation with dementia or cognitive impairment (n=21,962). Oral anticoagulants vs. Non-oral anticoagulant treatment was evaluated on All-cause mortality (HR 0.79, 95% CI 0.68-0.92). Oral anticoagulant treatment was associated with a lower risk of all-cause mortality (HR 0.79) compared to non-OAC treatment in atrial fibrillation patients with dementia.
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