Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
Serviço de Medicina III, Hospital Pulido Valente, CHLN, Lisbon, Portugal.
J Thromb Thrombolysis. 2023 Oct;56(3):474-484. doi: 10.1007/s11239-023-02843-5. Epub 2023 Jul 5.
Oral anticoagulation significantly reduces the incidence of dementia in atrial fibrillation patients. However, this protective effect has not been compared between Direct Oral Anticoagulants (DOAC) and Vitamin K antagonists' anticoagulants (VKA). We conducted an electronic search for potentially eligible studies through the bibliographic databases MEDLINE, CENTRAL, ClinicalTrials.gov, EMBASE and Web of Science. The outcome of interest was dementia. Random-effects meta-analysis was performed. Nine observational studies were included and 1,175,609 atrial fibrillation patients were enrolled. DOAC therapy was associated with a significant reduction when compared with patients under VKA therapy (hazard ratio 0.89; 95% confidence interval 0.80-0.99). The grade of confidence of our results was very low due to the risk of bias. DOAC therapy is associated with a significant decrease in the risk of dementia when compared with VKA therapy. However, the low certainty of the evidence along with the paucityof clinical trials dedicated to answering this important question underscores a need for global clinical research initiatives.
口服抗凝剂可显著降低房颤患者痴呆的发生率。然而，直接口服抗凝剂（DOAC）与维生素 K 拮抗剂抗凝剂（VKA）之间的这种保护作用尚未进行比较。我们通过文献数据库 MEDLINE、CENTRAL、ClinicalTrials.gov、EMBASE 和 Web of Science 进行了电子搜索，以寻找可能符合条件的研究。感兴趣的结局是痴呆。采用随机效应荟萃分析。纳入了 9 项观察性研究，共纳入了 1175609 例房颤患者。与接受 VKA 治疗的患者相比，DOAC 治疗与显著降低痴呆风险相关（风险比 0.89；95%置信区间 0.80-0.99）。由于存在偏倚风险，我们研究结果的可信度等级非常低。与 VKA 治疗相比，DOAC 治疗与痴呆风险的显著降低相关。然而，证据的确定性较低，以及专门用于回答这个重要问题的临床试验较少，突显了需要开展全球临床研究计划。
