Comparing the risk of dementia in subjects with atrial fibrillation using non-vitamin K antagonist oral anticoagulants versus vitamin K antagonists: a Belgian nationwide cohort study.
Background Atrial fibrillation (AF) is associated with cognitive decline, with anticoagulated subjects potentially having a reduced risk compared with non-anticoagulated subjects. However, whether non-vitamin K antagonist oral anticoagulants (NOACs) may reduce the risk of dementia compared with vita...
| Publicado en: | Age & Ageing Vol. 52; no. 3; pp. 1 - 10 |
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| Autores principales: | , , , , , |
| Formato: | Artículo |
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Oxford University Press / USA
Mar2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=162858665&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 162858665 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Mar2023 vid: 52 iid: 3 pid: 622 pub: Oxford University Press / USA artinfo: ui: 162858665 10.1093/ageing/afad038 ppf: 1 ppct: 9 formats: tig: atl: Comparing the risk of dementia in subjects with atrial fibrillation using non-vitamin K antagonist oral anticoagulants versus vitamin K antagonists: a Belgian nationwide cohort study. aug: au: Grymonprez, Maxim Petrovic, Mirko Backer, Tine L De Ikram, M Arfan Steurbaut, Stephane Lahousse, Lies affil: Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University , 9000 Ghent , Belgium Department of Geriatrics, Ghent University Hospital , 9000 Ghent , Belgium Department of Cardiology, Ghent University Hospital , 9000 Ghent , Belgium Department of Epidemiology, Erasmus Medical Center , 3000 Rotterdam, Th e Netherlands Centre for Pharmaceutical Research, Research group of Clinical Pharmacology and Clinical Pharmacy, Vrije Universiteit Brussel , 1090 Jette , Belgium Department of Hospital Pharmacy, UZ Brussel , 1090 Jette , Belgium Department of Epidemiology, Erasmus Medical Center , 3000 Rotterdam , The Netherlands su: Belgium Disease risk factors Dementia risk factors Alzheimer's disease risk factors Vascular dementia Pyridine Confidence intervals Atrial fibrillation Anticoagulants Regression analysis Health outcome assessment Benzimidazoles Belgians Rivaroxaban Research funding Cognitive testing Vitamin K Longitudinal method Probability theory Proportional hazards models Chemical inhibitors sug: subj: Disease risk factors Belgium Dementia risk factors Alzheimer's disease risk factors Vascular dementia Pyridine Confidence intervals Atrial fibrillation Anticoagulants Regression analysis Health outcome assessment Benzimidazoles Belgians Rivaroxaban Research funding Cognitive testing Vitamin K Longitudinal method Probability theory Proportional hazards models Chemical inhibitors keyword: Alzheimer's disease atrial fibrillation dementia non-vitamin K antagonist oral anticoagulants (NOAC) vitamin K antagonists (VKA) Alzheimer's disease atrial fibrillation dementia non-vitamin K antagonist oral anticoagulants (NOAC) vitamin K antagonists (VKA) ab: Background Atrial fibrillation (AF) is associated with cognitive decline, with anticoagulated subjects potentially having a reduced risk compared with non-anticoagulated subjects. However, whether non-vitamin K antagonist oral anticoagulants (NOACs) may reduce the risk of dementia compared with vitamin K antagonists (VKAs) is unclear yet. Therefore, the risk of dementia was compared between AF subjects on NOACs versus VKAs. Methods AF subjects initiating anticoagulation between 2013 and 2019 were identified in Belgian nationwide data. Inverse probability of treatment weighted Cox regression was used to investigate cognitive outcomes. Results Among 237,012 AF subjects (310,850 person-years (PYs)), NOAC use was associated with a significantly lower risk of dementia (adjusted hazard ratio (aHR) 0.91, 95% confidence interval (CI) (0.85–0.98)) compared with VKAs. A trend towards a lower risk of vascular dementia (aHR 0.89, 95% CI (0.76–1.04)) and significantly lower risk of other/unspecified dementia (aHR 0.91, 95% CI (0.84–0.99)) were observed with NOACs compared with VKAs, whereas the risk of Alzheimer's disease was similar (aHR 0.99, 95% CI (0.88–1.11)). Apixaban (aHR 0.91, 95% CI (0.83–0.99)) and edoxaban (aHR 0.79, 95% CI (0.63–0.99)) were associated with significantly lower risks of dementia compared with VKAs, while risks were not significantly different with dabigatran (aHR 1.02, 95% CI (0.93–1.12)) and rivaroxaban (aHR 0.97, 95% CI (0.90–1.05)). Comparable risks of dementia were observed between individual NOACs, except for significantly lower risks of dementia (aHR 0.93, 95% CI (0.87–0.98)) and other/unspecified dementia (aHR 0.90 (0.84–0.97)) with apixaban compared with rivaroxaban. Conclusion NOACs were associated with a significantly lower risk of dementia compared with VKAs, likely driven by apixaban and edoxaban use. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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