Cheng Wenke, Liu Weijun, Li Bin, Li Dongfang
Department of Cardiology, Affiliated Hospital of Qinghai University, Xining, China.
Department of public health, Qinghai University, Xining, China.
J Cardiovasc Pharmacol. 2018 Jun;71(6):380-387. doi: 10.1097/FJC.0000000000000575.
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.
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.
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) <25% versus 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).
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.
目前，人们认为心房颤动（AF）是认知障碍和痴呆的一个危险因素。它独立于中风，但AF患者中抗凝药物与认知功能之间的关系尚不清楚。
本研究的目的是完成一项研究的荟萃分析，并调查抗凝治疗与AF患者认知障碍之间的关联。
两名研究人员系统检索了Cochrane图书馆、PubMed、EMBASE数据库和Web of Science，以查找所有呈现关联的研究。提取并汇总风险比（HRs）。最后，纳入的8项研究共471,057名参与者；治疗范围内时间（TTR）<25%与TTR>75%相比；（HR 3.02，95%CI 1.12 - 8.91；P = 0.03）；TTR 25% - 50%与TTR>75%相比（HR 2.44，95%CI 0.95 - 6.22；P = 0.06）；TTR 50% - 75%与TTR>75%相比（HR 1.75，95%CI 0.90 - 3.99；P = 0.1）；口服抗凝剂（OAC）与未使用OAC相比（HR 0.71，95%CI 69 - 0.74；P < 0.00001）；新型口服抗凝剂与华法林相比（HR 0.51，95%CI 0.37 - 0.71；P < 0.00001）。
OACs显著降低AF患者认知障碍的发生率。与华法林相比，新型口服抗凝剂对认知具有有效的保护作用。在国际标准化比值（INR）2 - 3范围内，随着TTR的增加，认知障碍的发生率较低。
