Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Jiangxi Key Laboratory of Molecular Medicine, Nanchang, Jiangxi, China.
Clin Cardiol. 2023 Aug;46(8):866-876. doi: 10.1002/clc.24076. Epub 2023 Jun 27.
Atrial fibrillation (AF) patients are more susceptible to dementia, but the results about the effect of oral anticoagulants (OACs) on the risk of dementia are not consistent. We hypothesize that OAC is associated with a reduced risk of dementia with AF and that nonvitamin K antagonist oral anticoagulants (NOAC) are superior to vitamin K antagonists (VKA). Four databases were systematically searched until July 1, 2022. Two reviewers independently selected literature, evaluated quality, and extracted data. Data were examined using pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Fourteen research studies involving 910 patients were enrolled. The findings indicated that OACs were associated with a decreased risk of dementia (pooled HR: 0.68, 95% CI: 0.55-0.82, I = 87.7%), and NOACs had a stronger effect than VKAs (pooled HR: 0.87, 95% CI: 0.79-0.95, I = 72%), especially in participants with a CHA2DS2VASc score ≥ 2 (pooled HR: 0.85, 95% CI: 0.72-0.99). Subgroup analysis demonstrated no statistical significance among patients aged <65 years old (pooled HR: 0.83, 95% CI: 0.64-1.07), patients in "based on treatment" studies (pooled HR: 0.89, 95% CI: 0.75-1.06), or people with no stroke background (pooled HR: 0.90, 95% CI: 0.71-1.15). This analysis revealed that OACs were related to the reduction of dementia incidence in AF individuals, and NOACs were better than VKAs, remarkably in people with a CHA2DS2VASc score ≥ 2. The results should be confirmed by further prospective studies, particularly in patients in "based on treatment" studies aged <65 years old with a CHA2DS2VASc score < 2 or without a stroke background.
心房颤动（AF）患者更容易发生痴呆，但关于口服抗凝剂（OAC）对痴呆风险的影响结果并不一致。我们假设 OAC 与 AF 患者痴呆风险降低相关，且非维生素 K 拮抗剂口服抗凝剂（NOAC）优于维生素 K 拮抗剂（VKA）。系统检索了四个数据库，直到 2022 年 7 月 1 日。两位审查员独立筛选文献、评估质量并提取数据。使用合并危险比（HR）和 95%置信区间（CI）检查数据。共纳入 14 项研究涉及 910 名患者。结果表明，OAC 与痴呆风险降低相关（合并 HR：0.68，95%CI：0.55-0.82，I = 87.7%），且 NOAC 的作用强于 VKA（合并 HR：0.87，95%CI：0.79-0.95，I = 72%），特别是 CHA2DS2VASc 评分≥2 的参与者（合并 HR：0.85，95%CI：0.72-0.99）。亚组分析显示，年龄<65 岁的患者（合并 HR：0.83，95%CI：0.64-1.07）、“基于治疗”研究中的患者（合并 HR：0.89，95%CI：0.75-1.06）或无卒中背景的患者（合并 HR：0.90，95%CI：0.71-1.15）之间无统计学意义。本分析表明，OAC 与 AF 个体痴呆发病率降低相关，且 NOAC 优于 VKA，在 CHA2DS2VASc 评分≥2 的人群中效果更为显著。该结果需要进一步前瞻性研究证实，特别是在“基于治疗”研究中年龄<65 岁、CHA2DS2VASc 评分<2 或无卒中背景的患者。
