Impact of anticoagulation in patients with dementia and atrial fibrillation. Results of the CardioCHUVI-FA registry.

Autor: Cobas Paz R; Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain. Electronic address: rafacobaspaz@gmail.com., Raposeiras Roubín S; Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain., Abu Assi E; Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain., Barreiro Pardal C; Servicio de Anestesia, Hospital Universitario Montecelo, Pontevedra, Spain., García Comesaña J; Gerencia, Hospital Universitario de Orense, Orense, Spain., González-Carrero López A; Servicio de Admisión Hospitalaria, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain., Caneiro Queija B; Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain., Cespón Fernández M; Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain., Muñoz Pousa I; Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain., Domínguez Erquicia P; Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain., Domínguez Rodríguez LM; Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain., Carpintero Vara A; Servicio de Geriatría, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain., García Campo E; Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain., Rodríguez Pascual C; Servicio de Geriatría, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain., Íñiguez Romo A; Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
Jazyk: English; Spanish; Castilian
Zdroj: Revista espanola de cardiologia (English ed.) [Rev Esp Cardiol (Engl Ed)] 2020 Nov; Vol. 73 (11), pp. 877-884. Date of Electronic Publication: 2020 Feb 17.
DOI: 10.1016/j.rec.2019.10.025
Abstrakt: Introduction and Objectives: Population aging is associated with an increased prevalence of atrial fibrillation (AF) and dementia. This study aimed to analyze the impact of oral anticoagulation in elderly patients with AF and moderate-severe dementia.
Methods: We conducted a single-center retrospective study analyzing patients aged ≥ 85 years with a diagnosis of AF between 2013 and 2018. The impact of anticoagulation on mortality, embolisms, and bleeding events was assessed by multivariate Cox analysis. In patients with dementia, this analysis was complemented by propensity score matching, depending on whether the patients were prescribed anticoagulant treatment or not.
Results: Of the 3549 patients aged ≥ 85 years with AF, 221 had moderate-severe dementia (6.1%), of whom 88 (60.2%) were anticoagulated. During a follow-up of 2.8 ±1.7 years, anticoagulation was associated with lower embolic risk and higher bleeding risk both in patients with dementia (hazard ratio [HR] embolisms , 0.36; 95%CI, 0.15-0.84; HR bleeding , 2.44; 95%CI, 1.04-5.71) and in those without dementia (HR embolisms , 0.58; 95%CI, 0.45-0.74; HR bleeding , 1.55, 95%CI, 1.21-1.98). However, anticoagulation was associated with lower mortality only in patients without dementia (HR, 0.63; 95%CI, 0.53-0.75) and not in those with dementia (adjusted HR, 1.04; 95%CI, 0.63-1.72; P=.541; HR after propensity score matching 0.91, 95%CI, 0.45-1.83; P=.785).
Conclusions: In patients aged ≥ 85 years with moderate-severe dementia and AF, oral anticoagulation was significantly associated with a lower embolic risk and a higher bleeding risk, with no differences in total mortality.
(Copyright © 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze: MEDLINE
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