Department of Cardiology, Peking University First Hospital, Beijing, China.
The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Int J Clin Pract. 2021 Oct;75(10):e14269. doi: 10.1111/ijcp.14269. Epub 2021 May 2.
To assess the effect of oral anticoagulant (OAC) administration on incidence of dementia in patients with atrial fibrillation (AF) with Systematic review and meta-analysis.
We systematically searched the electronic databases including Pubmed, Embase, Cochrane library and ClinicalTrails.gov for relevant articles. The primary outcome was the incidence of dementia. The adjusted risk ratio (RR), odds ratio or hazard ratio were extracted and pooled by the random-effects models. Subgroup analysis was performed according to the setting observational window. Risk of bias was assessed using the Newcastle-Ottawa Scale, while publication bias was assessed by the Begg's and Egger's tests.
Nine studies were included in this review (2 prospective and 7 retrospective observational studies, including 613,920 patients). The results presented the significant association between OAC therapy and the reduced risk of dementia compared with no treatment (RR [95% CI] = 0.72 [0.60, 0.86], I = 97.2%; P = .000). In the subgroup analysis with an observational window, the pooled RR became statistically non-significant (including four studies, RR [95% CI] = 0.75 [0.51, 1.10], I = 98.8%; P = .000). There is no significant risk of bias and publication bias.
This study indicated the protective effect of OAC therapy for dementia in patients with AF. However, the results are limited because of high heterogeneity, inconsistent direction of effect in subgroup analysis with an observational window. Further prospective well-designed study is needed with longer follow-up duration in younger patients.
通过系统评价和荟萃分析评估口服抗凝剂（OAC）治疗对房颤（AF）患者痴呆发生率的影响。
我们系统地检索了电子数据库，包括 Pubmed、Embase、Cochrane 图书馆和 ClinicalTrails.gov，以查找相关文章。主要结局是痴呆的发生率。采用随机效应模型提取和汇总调整后的风险比（RR）、优势比或风险比。根据观察窗设置进行亚组分析。使用纽卡斯尔-渥太华量表评估偏倚风险，使用贝格和埃格检验评估发表偏倚。
本综述纳入了 9 项研究（2 项前瞻性研究和 7 项回顾性观察性研究，共纳入 613920 名患者）。结果表明，与未治疗相比，OAC 治疗与痴呆风险降低显著相关（RR [95%CI] = 0.72 [0.60, 0.86]，I² = 97.2%；P = 0.000）。在观察窗的亚组分析中，汇总 RR 变得无统计学意义（包括 4 项研究，RR [95%CI] = 0.75 [0.51, 1.10]，I² = 98.8%；P = 0.000）。没有明显的偏倚和发表偏倚风险。
本研究表明 OAC 治疗对 AF 患者痴呆有保护作用。然而，由于存在高度异质性，以及在观察窗亚组分析中效应方向不一致，结果受到限制。需要进一步进行前瞻性、设计良好、随访时间更长的针对年轻患者的研究。
