Fang Chen-Wen, Hsieh Cheng-Yang, Yang Hsin-Yi, Tsai Ching-Fang, Sung Sheng-Feng
Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan.
Department of Neurology, National Taiwan University Hospital, Yunlin Branch, Douliu City, Taiwan.
Eur Stroke J. 2025 Mar;10(1):128-136. doi: 10.1177/23969873241274598. Epub 2024 Aug 30.
Developing an effective stroke prevention strategy is crucial for elderly atrial fibrillation (AF) patients with dementia. This is due to the limited and inconsistent evidence available on this topic. In this nationwide, population-based cohort study, we aim to compare the effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin in AF patients with dementia.
We identified AF patients with dementia, aged 50 years or older, from Taiwan's National Health Insurance Research Database between 2010 and 2019. The primary outcome was a composite of hospitalizations due to ischemic stroke, acute myocardial infarction, intracranial hemorrhage, or major bleeding, as well as all-cause mortality. We used 1:1 propensity score matching and Cox proportional hazard models to adjust for confounding factors when comparing outcomes between warfarin and DOAC (apixaban, dabigatran, edoxaban, or rivaroxaban) users or warfarin and each individual DOAC.
There were 2952 patients in the DOAC-warfarin matched cohort. The apixaban-, dabigatran-, edoxaban-, and rivaroxaban-warfarin matched cohorts had 2346, 2554, 1684, and 2938 patients, respectively. The DOAC group, when compared to warfarin, was associated with a lower risk of both the composite outcome (hazard ratio (HR), 0.81; 95% confidence interval (CI) 0.69-0.95) and ischemic stroke (HR 0.65; 95% CI 0.48-0.87). Apixaban (HR 0.79; 95% CI 0.66-0.94), dabigatran (HR 0.64; 95% CI 0.53-0.77), and rivaroxaban (HR 0.82; 95% CI 0.70-0.97) were also associated with a lower risk of the composite outcome.
Compared to warfarin, DOACs, whether as a group or apixaban, dabigatran, or rivaroxaban individually, were associated with a reduced risk of the composite outcome in elderly patients with concurrent AF and dementia.
制定有效的中风预防策略对于患有痴呆症的老年房颤（AF）患者至关重要。这是因为关于该主题的现有证据有限且不一致。在这项全国性的基于人群的队列研究中，我们旨在比较直接口服抗凝剂（DOACs）和华法林在患有痴呆症的房颤患者中的有效性和安全性。
我们从2010年至2019年台湾国民健康保险研究数据库中识别出年龄在50岁及以上的患有痴呆症的房颤患者。主要结局是因缺血性中风、急性心肌梗死、颅内出血或大出血导致的住院以及全因死亡率的综合结果。在比较华法林与DOAC（阿哌沙班、达比加群、依度沙班或利伐沙班）使用者之间或华法林与每种单独的DOAC之间的结局时，我们使用1:1倾向评分匹配和Cox比例风险模型来调整混杂因素。
DOAC-华法林匹配队列中有2952名患者。阿哌沙班-华法林、达比加群-华法林、依度沙班-华法林和利伐沙班-华法林匹配队列分别有2346名、2554名、1684名和2938名患者。与华法林相比，DOAC组的综合结局风险（风险比（HR），0.81；95%置信区间（CI）0.69 - 0.95）和缺血性中风风险（HR 0.65；95% CI 0.48 - 0.87）均较低。阿哌沙班（HR 0.79；95% CI 0.66 - 0.94）、达比加群（HR 0.64；95% CI 0.53 - 0.77）和利伐沙班（HR 0.82；95% CI 0.70 - 0.97）也与较低的综合结局风险相关。
与华法林相比，DOACs无论是作为一个整体还是阿哌沙班、达比加群或利伐沙班单独使用，在患有房颤和痴呆症的老年患者中均与较低的综合结局风险相关。
