Warfarin treatment in patients with dementia and atrial fibrillation was associated with a lower risk of ischemic stroke compared to no treatment (HR 0.76; 95% CI 0.59-0.98).
Cohort (n=8,096)
Yes
Does warfarin or antiplatelet treatment reduce ischemic stroke and mortality compared to no treatment in patients with dementia and atrial fibrillation?
In patients with dementia and atrial fibrillation, warfarin is associated with a lower risk of ischemic stroke and mortality compared to no treatment, supporting its use in appropriate cases despite a small increase in hemorrhage.
Effect estimate: HR 0.76 (95% CI 0.59-0.98)
Absolute Event Rate: 5.2% vs 8.7%
p-value: p=<0.001
BACKGROUND: Patients with dementia might have higher risk for hemorrhagic complications with anticoagulant therapy prescribed for atrial fibrillation (AF). OBJECTIVE: This study assesses the risks and benefits of warfarin, antiplatelets, and no treatment in patients with dementia and AF. METHODS: Of 49,792 patients registered in the Swedish Dementia Registry 2007-2014, 8,096 (16%) had a previous diagnosis of AF. Cox proportional hazards models were used to calculate the risk for ischemic stroke (IS), nontraumatic intracranial hemorrhage, any-cause hemorrhage, and death. RESULTS: Out of the 8,096 dementia patients with AF, 2,143 (26%) received warfarin treatment, 2,975 (37%) antiplatelet treatment, and 2,978 (37%) had no antithrombotic treatment at the time of dementia diagnosis. Patients on warfarin had fewer IS than those without treatment (5.2% versus 8.7%; p < 0.001) with no differences compared to antiplatelets. In adjusted analyses, warfarin was associated with a lower risk for IS (HR 0.76, CI 0.59-0.98), while antiplatelets were associated with increased risk (HR 1.25, CI 1.01-1.54) compared to no treatment. For any-cause hemorrhage, there was a higher risk with warfarin (HR 1.28, CI 1.03-1.59) compared to antiplatelets. Warfarin and antiplatelets were associated with a lower risk for death compared to no treatment. CONCLUSIONS: Warfarin treatment in Swedish patients with dementia is associated with lower risk of IS and mortality, and a small increase in any-cause hemorrhage. This study supports the use of warfarin in appropriate cases in patients with dementia. The low percentage of patients on warfarin treatment indicates that further gains in stroke prevention are possible.
Šubic et al. (Thu,) conducted a cohort in Dementia and Atrial Fibrillation (n=8,096). Warfarin vs. No treatment and antiplatelets was evaluated on Ischemic stroke (HR 0.76, 95% CI 0.59-0.98, p=<0.001). Warfarin treatment in patients with dementia and atrial fibrillation was associated with a lower risk of ischemic stroke compared to no treatment (HR 0.76; 95% CI 0.59-0.98).