Patients with dementia and atrial fibrillation less frequently receive direct oral anticoagulants (DOACs) and experience higher thrombotic and mortality risk.

Autor: Jurin I; Cardiology Department, University Hospital Dubrava, Zagreb, Croatia., Lucijanić M; Hematology Department, University Hospital Dubrava, Zagreb, Croatia.; School of Medicine, University of Zagreb, Zagreb, Croatia., Radonić V; Division of Cardiology, Department of Medicine, University Hospital Merkur, Zagreb, Croatia., Letilović T; School of Medicine, University of Zagreb, Zagreb, Croatia.; Division of Cardiology, Department of Medicine, University Hospital Merkur, Zagreb, Croatia., Pejić J; Thoracic Surgery Department, University Hospital Dubrava, Zagreb, Croatia., Lucijanić J; Health Care Center Zagreb-West, Zagreb, Croatia., Tješić-Drinković I; Gastroenterology, Hepatology and Clinical Nutrition Department, University Hospital Dubrava, Zagreb, Croatia., Sokol Tomić S; Cardiology Department, University Hospital Dubrava, Zagreb, Croatia., Hadžibegović I; Cardiology Department, University Hospital Dubrava, Zagreb, Croatia.; Faculty of DentalMedicine, Josip Juraj Strossmayer University, Osijek, Croatia.
Jazyk: angličtina
Zdroj: Acta clinica Belgica [Acta Clin Belg] 2022 Jun; Vol. 77 (3), pp. 565-570. Date of Electronic Publication: 2021 Apr 09.
DOI: 10.1080/17843286.2021.1913547
Abstrakt: Objective: To investigate differences in clinical presentation, anticoagulation pattern and outcomes in patients with dementia and atrial fibrillation (AF).
Methods: A total of 1217 hospitalized patients with non-valvular AF from two institutions were retrospectively evaluated. Diagnosis of dementia was established by a psychiatrist or a neurologist prior to or during hospitalization. Adequacy of warfarin anticoagulation was assessed during follow-up using at least 10 standardized international ratio values. In addition to unmatched comparison, nested case-control study was performed to further evaluate differences in clinical outcomes between patients with and without dementia.
Results: A total of 162/1217 (13.3%) patients were diagnosed with dementia. Among other associations, patients with dementia were significantly older with higher number of comorbidities, had lower estimated glomerular filtration rate (eGFR) and lower left ventricular ejection fraction (LVEF), (P < 0.05 for all analyses). Patients with dementia were significantly less likely to receive direct oral anticoagulants (DOACs; 27.2% vs 40.3%; P = 0.001) and were significantly more likely to be inadequately anticoagulated with warfarin (38.9% vs 28.6%; P = 0.008) than patients without dementia. After matching based on age, eGFR, LVEF, and CHA 2 DS 2 -VAS C patients with dementia were significantly more likely to experience inferior overall survival (HR = 1.8; P = 0.001) and shorter time to thrombosis (HR = 2.3; P = 0.019).
Conclusion: Our findings speak in support of increased thrombotic and mortality risks in patients with dementia, possibly due to inadequate anticoagulation and higher number of comorbidities.
Databáze: MEDLINE
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