Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK; Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Eur J Intern Med. 2024 Mar;121:114-120. doi: 10.1016/j.ejim.2023.10.033. Epub 2023 Oct 31.
Atrial fibrillation (AF) is associated with increased risk of dementia. Whether direct oral anticoagulation (DOAC) reduce this risk compared to vitamin-K antagonist (VKA) is unclear. The aim of this study was to assess the risk of new all-cause dementia and vascular dementia in AF patients, treated with either DOAC or VKAs.
Anonymized electronic medical records from the TriNetX federated research network were used. AF patients treated with DOACs within 1 month of AF diagnosis, were 1:1 propensity score-matched with those treated with a VKA. The analysis included patients who completed 5 and 10 years of follow-up and were assessed for all-cause dementia and vascular dementia. Cox proportional hazard models were used to hazard ratios (HR), respectively with 95% confidence intervals (CIs).
Among patients who completed 5 years of follow-up, after propensity score matching the final cohort consisted of 215,404 well-matched AF patients. All-cause dementia was diagnosed in 4,153 (3.9%) patients among those treated with DOACs and 4,150 (3.9%) among the VKA-treated patients (HR: 1.01, 95%CI: 0.96-1.05). Among patients 65-74 years old who were followed, DOAC treatment was associated with lower risk of dementia compared to VKAs (HR: 0.72; 95%CI: 0.59-0.86). Among patients who completed 10 years of follow-up, after propensity score matching the final cohort consisted of 19,208 well-matched AF patients. All-cause dementia was diagnosed in 314 (3.3%) patients among those treated with DOACs and 451 (4.7%) among the VKA-treated patients. DOAC treatment was associated with significantly lower risk of all-cause dementia during a follow-up period of 10 years compared to VKA treatment (HR: 0.72, 95%CI: 0.62-0.83), which remained consistent in patiens ≥65 years old.
This propensity-score matched analysis showed that among AF patients, treatment with a DOACs for a period of 10 years was associated with lower risk of all-cause dementia and vascular dementia compared to VKA treatment, an effect which was not apparent in those treated for shorter duration. This finding requires confirmation in ongoing randomised controlled trials.
心房颤动（AF）与痴呆风险增加相关。与维生素 K 拮抗剂（VKA）相比，直接口服抗凝剂（DOAC）是否能降低这种风险尚不清楚。本研究旨在评估 AF 患者接受 DOAC 或 VKA 治疗后新发全因痴呆和血管性痴呆的风险。
使用 TriNetX 联邦研究网络的匿名电子病历。AF 患者在诊断后 1 个月内接受 DOAC 治疗，按 1:1 倾向评分匹配接受 VKA 治疗的患者。分析包括完成 5 年和 10 年随访的患者，并评估全因痴呆和血管性痴呆。使用 Cox 比例风险模型计算风险比（HR），置信区间（CI）为 95%。
在完成 5 年随访的患者中，经过倾向评分匹配后，最终队列由 215404 名匹配良好的 AF 患者组成。在接受 DOAC 治疗的患者中，有 4153 例（3.9%）诊断为全因痴呆，在接受 VKA 治疗的患者中，有 4150 例（3.9%）诊断为全因痴呆（HR：1.01，95%CI：0.96-1.05）。在年龄在 65-74 岁且接受随访的患者中，与 VKA 相比，DOAC 治疗与痴呆风险降低相关（HR：0.72；95%CI：0.59-0.86）。在完成 10 年随访的患者中，经过倾向评分匹配后，最终队列由 19208 名匹配良好的 AF 患者组成。在接受 DOAC 治疗的患者中，有 314 例（3.3%）诊断为全因痴呆，在接受 VKA 治疗的患者中，有 451 例（4.7%）诊断为全因痴呆。与 VKA 治疗相比，在 10 年的随访期间，DOAC 治疗与全因痴呆的风险显著降低相关（HR：0.72，95%CI：0.62-0.83），这一结果在年龄≥65 岁的患者中仍然一致。
这项倾向评分匹配分析表明，在 AF 患者中，与 VKA 治疗相比，接受 DOAC 治疗 10 年与全因痴呆和血管性痴呆的风险降低相关，而在接受较短时间治疗的患者中，这种效果并不明显。这一发现需要在正在进行的随机对照试验中得到证实。
