Kalloo Amy E, Slouha Ethan, Gallagher Connor P, Razeq Ziyad, Gorantla Vasavi Rakesh
Clinical Sciences, St. George's University School of Medicine, True Blue, GRD.
Anatomical Sciences, St. George's University School of Medicine, True Blue, GRD.
Cureus. 2023 May 30;15(5):e39693. doi: 10.7759/cureus.39693. eCollection 2023 May.
Many patients diagnosed with atrial fibrillation (AF) develop dementia. Most AF patients are also prescribed some antithrombotic medication to reduce the incidence of stroke, as clots can form within the left atrium. Some research has found that, excluding patients who have experienced strokes, anticoagulants may serve as protective agents against dementia in AF. This systematic review aims to analyze the incidence of dementia in patients who were prescribed anticoagulants. A comprehensive literature review was conducted using the databases PubMed, ProQuest, and ScienceDirect. Only experimental studies and meta-analyses were chosen. The search included the keywords "dementia and anticoagulant" and "cognitive decline and anticoagulants". Our initial search generated 53,306 articles, which were narrowed down to 29 by applying strict inclusion and exclusion algorithms. There was a decreased risk of dementia in patients who had been prescribed oral anticoagulants (OACs) in general, but only studies investigating direct oral anticoagulants OACs (DOACs) suggested that they were protective against dementia. Vitamin K antagonist (VKA) anticoagulants showed conflicting results, with some studies indicating they might increase the risk for dementia, while others suggested that they are protective against it. Warfarin, a specific VKA, was mainly shown to reduce the risk of dementia but was not as effective as DOACs or other OACs. Lastly, it was found that antiplatelet therapy may increase the risk of dementia in AF patients.
许多被诊断为心房颤动（AF）的患者会患上痴呆症。大多数房颤患者还会被开一些抗血栓药物，以降低中风的发生率，因为左心房内可能形成血栓。一些研究发现，排除中风患者后，抗凝剂可能对房颤患者的痴呆症起到保护作用。本系统评价旨在分析服用抗凝剂患者的痴呆症发病率。使用PubMed、ProQuest和ScienceDirect数据库进行了全面的文献综述。只选择了实验研究和荟萃分析。搜索关键词包括“痴呆症与抗凝剂”和“认知能力下降与抗凝剂”。我们最初的搜索产生了53306篇文章，通过应用严格的纳入和排除算法，将其缩小到29篇。一般来说，服用口服抗凝剂（OAC）的患者患痴呆症的风险降低，但只有研究直接口服抗凝剂（DOAC）的研究表明它们对痴呆症有保护作用。维生素K拮抗剂（VKA）抗凝剂的结果相互矛盾，一些研究表明它们可能会增加患痴呆症的风险，而另一些研究则表明它们对痴呆症有保护作用。华法林，一种特定的VKA，主要显示可降低痴呆症风险，但不如DOAC或其他OAC有效。最后，研究发现抗血小板治疗可能会增加房颤患者患痴呆症的风险。
