Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Department of Medicine, University of California, Los Angeles.
Mayo Clin Proc. 2018 Feb;93(2):145-154. doi: 10.1016/j.mayocp.2017.09.021. Epub 2018 Jan 9.
To study the association between time in therapeutic range (TTR) during warfarin therapy and risk of dementia in a population-based cohort of incident atrial fibrillation (AF).
We conducted an observational population-based study of 2800 nondemented patients with incident AF from January 1, 2000, through December 31, 2010. The association of incident dementia with warfarin therapy and TTR was examined using Cox proportional hazards regression models.
Mean patient age was 71.2 years; 53% were men (n=1495), and warfarin was prescribed to 50.5% (n=1414) within 90 days of AF diagnosis. Incident dementia diagnosis occurred in 357 patients (12.8%) over a mean ± SD follow-up of 5.0±3.7 years. After adjusting for confounders, warfarin therapy was associated with a reduced incidence of dementia (hazard ratio [HR], 0.80; 95% CI, 0.64-0.99). However, only those in the 2 highest quartiles of TTR were associated with lower risk of dementia. A 10% increase in TTR with a 10% reduction in time spent in the subtherapeutic (HR, 0.71; 95% CI, 0.64-0.79) and supratherapeutic (HR, 0.67; 95% CI, 0.57-0.79) ranges were associated with decreased risk of dementia.
In the community, warfarin therapy for AF is associated with a 20% reduction in risk of dementia. Increasing TTR on warfarin is associated with reduced risk of dementia. The risk of dementia was reduced with a reduction in time spent in subtherapeutic and supratherapeutic international normalized ratio range. Effective anticoagulation may prevent cognitive impairment in patients with AF.
在一项基于人群的首发心房颤动（AF）队列中，研究华法林治疗期间治疗范围时间（TTR）与痴呆风险之间的关联。
我们对 2000 年 1 月 1 日至 2010 年 12 月 31 日期间首发 AF 的 2800 名非痴呆患者进行了一项观察性基于人群的研究。使用 Cox 比例风险回归模型检查痴呆与华法林治疗和 TTR 的关联。
平均患者年龄为 71.2 岁；53%为男性（n=1495），AF 诊断后 90 天内开具华法林处方的比例为 50.5%（n=1414）。平均随访 5.0±3.7 年后，357 例患者（12.8%）被诊断为新发痴呆。在校正混杂因素后，华法林治疗与痴呆发生率降低相关（风险比 [HR]，0.80；95%置信区间，0.64-0.99）。然而，只有 TTR 最高的 2 个四分位数与痴呆风险降低相关。TTR 增加 10%，治疗范围（HR，0.71；95%置信区间，0.64-0.79）和超治疗范围（HR，0.67；95%置信区间，0.57-0.79）时间减少 10%，痴呆风险降低。
在社区中，AF 华法林治疗与痴呆风险降低 20%相关。华法林 TTR 增加与痴呆风险降低相关。治疗范围和超治疗范围 INR 时间减少与痴呆风险降低相关。有效的抗凝治疗可能预防 AF 患者的认知障碍。
