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Thromb Haemost 2024; 124(03): 253-262
DOI: 10.1055/a-2184-7506
Stroke, Systemic or Venous Thromboembolism

Risk of Incident Atrial Fibrillation and Subsequent Use of Oral Anticoagulants in Patients with Dementia

Chuan-Tsai Tsai   *
1   Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
2   Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
,
Yi-Hsin Chan   *
3   The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
4   College of Medicine, Chang Gung University, Taoyuan, Taiwan
5   Microscopy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
,
Jo-Nan Liao
1   Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
2   Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
,
Tzeng-Ji Chen
6   Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
,
Gregory Y. H. Lip   **
7   Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom and Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
,
Shih-Ann Chen   **
1   Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
2   Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
8   Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
,
Tze-Fan Chao
1   Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
2   Institute of Clinical Medicine and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
› Author Affiliations Funding This work was supported in part by grants from the Ministry of Science and Technology (MOST 107–2314-B-075–062-MY3), Taipei Veterans General Hospital (V108B-015, V108B-027, V108C-090, V109C-042, V109C-186), Research Foundation of Cardiovascular Medicine, and Szu-Yuan Research Foundation of Internal Medicine, Taipei, Taiwan.
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Abstract

Background Dementia and atrial fibrillation (AF) have many shared risk factors. Besides, patients with dementia are under-represented in randomized trials, and even if AF is present, oral anticoagulants (OACs) are not prescribed frequently. This study aimed to report the incidence of newly diagnosed AF in dementia patients, and the impacts of use of vitamin K antagonist (VKA; e.g., warfarin) and non-VKA OAC (NOACs) on stroke and bleeding outcomes.

Methods Our study utilized the Taiwan National Health Insurance Research Database. A total of 554,074 patients with dementia were compared with 554,074 age- and sex-matched patients without dementia regarding the risk of incident AF. Among patients with dementia who experienced incident AF, the risks of clinical events of patients treated with warfarin or NOACs were compared with those without OACs (reference group).

Results The risk of incident AF was greater for patients with dementia compared with those without (adjusted hazard ratio [aHR]: 1.054; 95% confidence interval [CI]: 1.040–1.068 for all types of dementia, aHR: 1.035; 95% CI: 1.020–1.051 for presenile/senile dementia, and aHR: 1.125; 95% CI: 1.091–1.159 for vascular dementia). Among patients with dementia and experienced incident AF, warfarin use was associated with a higher risk of ischemic stroke (aHR: 1.290; 95% CI: 1.156–1.440), intracranial hemorrhage (ICH; aHR: 1.678; 95% CI: 1.346–2.090), and major bleeding (aHR: 1.192; 95% CI: 1.073–1.323) compared with non-OACs. NOAC use was associated with a lower risk of ischemic stroke (aHR: 0.421; 95% CI: 0.352–0.503) and composite risk of ischemic stroke or major bleeding (aHR: 0.544; 95% CI: 0.487–0.608) compared with non-OACs. These results were consistent among the patients after the propensity matching.

Conclusion In this large nationwide cohort, the risk of newly diagnosed AF was higher in patients with dementia (all dementia, presenile/senile dementia, and vascular dementia) compared with those without dementia. For patients with dementia who experienced incident AF, NOAC use was associated with a better clinical outcome compared with non-OAC. Patients with dementia require a holistic approach to their care and management, including the use of NOACs to reduce the risks of clinical events.

Keywords

atrial fibrillation - dementia - NOACs

Data Availability Statement

The data underlying this article cannot be shared publicly due to ethical/privacy reasons.


Authors' Contribution

Study concept and design: C.-T.T., T.-F.C., G.Y.H.L., S.-A.C. Acquisition of data: T.-J.C., Y.-H.C. Analysis and interpretation of data: T.-F.C., G.Y.H.L., S.-A.C. Drafting of the manuscript: C.-T.T., T.-F.C., G.Y.H.L. Critical revision of the manuscript for important intellectual content: G.Y.H.L., S.-A.C. Statistical analysis: T.-F.C., J.-N.L. Study supervision: G.Y.H.L., S.-A.C.


* These authors are co-first authors.


** These authors are joint senior authors.


The review process for this paper was fully handled by Christian Weber, Editor in Chief.


Supplementary Material



Publication History

Received: 25 September 2023

Accepted: 29 September 2023

Accepted Manuscript online:
30 September 2023

Article published online:
30 October 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
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