TY - JOUR
T1 - Oral anticoagulants and risk of dementia
T2 - A systematic review and meta-analysis of observational studies and randomized controlled trials
AU - Mongkhon, Pajaree
AU - Naser, Abdallah Y.
AU - Fanning, Laura
AU - Tse, Gary
AU - Lau, Wallis C.Y.
AU - Wong, Ian C.K.
AU - Kongkaew, Chuenjid
N1 - Publisher Copyright:
© 2018 Elsevier Ltd
PY - 2019/1
Y1 - 2019/1
N2 - Atrial fibrillation (AF) is a documented risk factor for dementia. However, it is unclear whether oral anticoagulant (OAC) treatment can reduce the development of dementia or cognitive impairment. We conducted a systematic review and meta-analysis of the association between OAC use and subsequent dementia development in AF patients by searching databases from their inception to February 2018 without language restriction. Six studies (one randomized controlled trial and five observational studies) met the inclusion criteria. The pooled adjusted risk ratios (RRs) suggested a protective effect of OAC use in reducing dementia risk (RR 0.79 [95% CI: 0.67 – 0.93], I2 = 59.7%; P = 0.005). Further, high percentage of time in therapeutic range (TTR) was associated with a decreased risk of dementia (RR 0.38 [95% CI 0.22-0.64], I2 = 81.8%; P < 0.001). Our results support the hypothesis that AF-related dementia may be due to silent brain infarcts and micro-embolism that could be prevented by OAC use. Future studies with prospective follow-up with direct comparison of vitamin K antagonists and direct oral anticoagulants are needed.
AB - Atrial fibrillation (AF) is a documented risk factor for dementia. However, it is unclear whether oral anticoagulant (OAC) treatment can reduce the development of dementia or cognitive impairment. We conducted a systematic review and meta-analysis of the association between OAC use and subsequent dementia development in AF patients by searching databases from their inception to February 2018 without language restriction. Six studies (one randomized controlled trial and five observational studies) met the inclusion criteria. The pooled adjusted risk ratios (RRs) suggested a protective effect of OAC use in reducing dementia risk (RR 0.79 [95% CI: 0.67 – 0.93], I2 = 59.7%; P = 0.005). Further, high percentage of time in therapeutic range (TTR) was associated with a decreased risk of dementia (RR 0.38 [95% CI 0.22-0.64], I2 = 81.8%; P < 0.001). Our results support the hypothesis that AF-related dementia may be due to silent brain infarcts and micro-embolism that could be prevented by OAC use. Future studies with prospective follow-up with direct comparison of vitamin K antagonists and direct oral anticoagulants are needed.
KW - Anticoagulant
KW - Atrial fibrillation
KW - Cognitive impairment
KW - Dementia
KW - Direct oral anticoagulants
KW - Warfarin
UR - http://www.scopus.com/inward/record.url?scp=85056655865&partnerID=8YFLogxK
U2 - 10.1016/j.neubiorev.2018.10.025
DO - 10.1016/j.neubiorev.2018.10.025
M3 - Review article
C2 - 30391408
AN - SCOPUS:85056655865
SN - 0149-7634
VL - 96
SP - 1
EP - 9
JO - Neuroscience and Biobehavioral Reviews
JF - Neuroscience and Biobehavioral Reviews
ER -