Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
Heart. 2021 Dec;107(23):1898-1904. doi: 10.1136/heartjnl-2021-319672. Epub 2021 Oct 13.
The aim of this study was to investigate the association between oral anticoagulant type (direct oral anticoagulants (DOACs) vs vitamin K antagonists (VKAs)) and incident dementia or mild cognitive impairment (MCI) among patients with newly diagnosed atrial fibrillation (AF).
Using linked electronic health record (EHR) data from the Clinical Practice Research Datalink in the UK, we conducted a historical cohort study among first-time oral anticoagulant users with incident non-valvular AF diagnosed from 2012 to 2018. We compared the incidence of (1) clinically coded dementia and (2) MCI between patients prescribed VKAs and DOACs using Cox proportional hazards regression models, with age as the underlying timescale, accounting for calendar time and time on treatment, sociodemographic and lifestyle factors, clinical comorbidities and medications.
Of 39 200 first-time oral anticoagulant users (44.6% female, median age 76 years, IQR 68-83), 20 687 (53%) were prescribed a VKA and 18 513 (47%) a DOAC at baseline. Overall, 1258 patients (3.2%) had GP-recorded incident dementia, incidence rate 16.5 per 1000 person-years. DOAC treatment for AF was associated with a 16% reduction in dementia diagnosis compared with VKA treatment in the whole cohort (adjusted HR 0.84, 95% CI: 0.73 to 0.98) and with a 26% reduction in incident MCI (adjusted HR 0.74, 95% CI: 0.65 to 0.84). Findings were similar across various sensitivity analyses.
Incident EHR-recorded dementia and MCI were less common among patients prescribed DOACs for new AF compared with those prescribed VKAs.
本研究旨在探讨新型口服抗凝剂（直接口服抗凝剂（DOACs）与维生素 K 拮抗剂（VKAs））类型与新发心房颤动（AF）患者发生痴呆或轻度认知障碍（MCI）的相关性。
利用英国临床实践研究数据链接（CPRD）中的电子健康记录（EHR）数据，我们开展了一项历史性队列研究，纳入了 2012 年至 2018 年间首次诊断为非瓣膜性 AF 的新型口服抗凝剂使用者。我们通过 Cox 比例风险回归模型比较了 VKAs 和 DOACs 处方患者（1）临床确诊痴呆和（2）MCI 的发生率，年龄为基础时间尺度，考虑了日历时间和治疗时间、社会人口统计学和生活方式因素、临床合并症和药物。
39200 例首次接受口服抗凝治疗的患者（44.6%女性，中位年龄 76 岁，IQR 68-83）中，20687 例（53%）基线时处方 VKAs，18513 例（47%）处方 DOACs。总体而言，1258 例患者（3.2%）有 GP 记录的新发痴呆，发病率为 16.5 例/1000人年。与 VKA 治疗相比，DOAC 治疗 AF 与痴呆诊断减少 16%相关（调整后的 HR 0.84，95%CI：0.73 至 0.98），与新发 MCI 减少 26%相关（调整后的 HR 0.74，95%CI：0.65 至 0.84）。各种敏感性分析的结果均相似。
与 VKAs 相比，新型 AF 患者处方 DOACs 的患者发生 EHR 记录的痴呆和 MCI 的情况较少。
