School of Pharmacy, University of Eastern Finland, PO Box 1627, 70210, Kuopio, Finland.
Kuopio Research Center of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
BMC Geriatr. 2022 May 28;22(1):464. doi: 10.1186/s12877-022-03144-x.
Although cardio- and cerebrovascular diseases are common among people with Alzheimer's disease (AD), it is unknown how the prevalence of oral anticoagulant (OAC) use changes in relation to AD diagnosis. We investigated the prevalence of OAC use in relation to AD diagnosis in comparison to a matched cohort without AD.
Register-based Medication use and Alzheimer's disease (MEDALZ) cohort includes 70 718 Finnish people with AD diagnosed between 2005-2011. Point prevalence of OAC use (prescription register) was calculated every three months with three-month evaluation periods, from five years before to five years after clinically verified diagnosis and compared to matched cohort without AD. Longitudinal association between AD and OAC use was evaluated by generalized estimating equations (GEE).
OAC use was more common among people with AD until AD diagnosis, (OR 1.17; 95% CI 1.13-1.22), and less common after AD diagnosis (OR 0.87; 95% CI 0.85-0.89), compared to people without AD. At the time of AD diagnosis, prevalence was 23% and 20% among people with and without AD, respectively. OAC use among people with AD began to decline gradually two years after AD diagnosis while continuous increase was observed in the comparison cohort. Warfarin was the most common OAC, and atrial fibrillation was the most common comorbidity in OAC users.
Decline in OAC use among people with AD after diagnosis may be attributed to high risk of falling and problems in monitoring. However, direct oral anticoagulants (DOACs) that are nowadays more commonly used require less monitoring and may also be safer for vulnerable people with AD.
尽管心脑血管疾病在阿尔茨海默病（AD）患者中很常见，但尚不清楚口服抗凝剂（OAC）的使用频率如何随 AD 诊断而变化。我们调查了与 AD 诊断相关的 OAC 使用频率与无 AD 匹配队列的比较。
基于登记的药物使用和阿尔茨海默病（MEDALZ）队列包括 70718 名芬兰人，他们在 2005-2011 年间被诊断为 AD。OAC 使用的时点患病率（处方登记）在从临床确诊前五年到五年后，每三个月计算一次，评估期为三个月，并与无 AD 的匹配队列进行比较。使用广义估计方程（GEE）评估 AD 和 OAC 使用之间的纵向关联。
在 AD 诊断之前，OAC 的使用在 AD 患者中更为常见（OR 1.17；95%CI 1.13-1.22），而在 AD 诊断之后则较少（OR 0.87；95%CI 0.85-0.89），与无 AD 的患者相比。在 AD 诊断时，AD 患者和无 AD 患者的 OAC 使用比例分别为 23%和 20%。AD 诊断后两年，AD 患者的 OAC 使用开始逐渐下降，而对照组则持续增加。华法林是最常用的 OAC，OAC 使用者中最常见的合并症是心房颤动。
AD 患者诊断后 OAC 使用减少可能归因于跌倒风险高和监测问题。然而，现在更常用的直接口服抗凝剂（DOAC）需要较少的监测，并且对脆弱的 AD 患者也可能更安全。
