Cargando…
Association of Oral Anticoagulant Type With Risk of Dementia Among Patients With Nonvalvular Atrial Fibrillation
BACKGROUND: Oral anticoagulants (OACs) in patients with atrial fibrillation (AF), in addition to reducing stroke risk, could also prevent adverse cognitive outcomes. The purpose of this study was to compare the risk of dementia incidence across patients with AF initiating different OACs. METHODS AND...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404188/ https://www.ncbi.nlm.nih.gov/pubmed/30571385 http://dx.doi.org/10.1161/JAHA.118.009561 |
_version_ | 1783400819850215424 |
---|---|
author | Chen, Nemin Lutsey, Pamela L. MacLehose, Richard F. Claxton, J'Neka S. Norby, Faye L. Chamberlain, Alanna M. Bengtson, Lindsay G. S. O'Neal, Wesley T. Chen, Lin Y. Alonso, Alvaro |
author_facet | Chen, Nemin Lutsey, Pamela L. MacLehose, Richard F. Claxton, J'Neka S. Norby, Faye L. Chamberlain, Alanna M. Bengtson, Lindsay G. S. O'Neal, Wesley T. Chen, Lin Y. Alonso, Alvaro |
author_sort | Chen, Nemin |
collection | PubMed |
description | BACKGROUND: Oral anticoagulants (OACs) in patients with atrial fibrillation (AF), in addition to reducing stroke risk, could also prevent adverse cognitive outcomes. The purpose of this study was to compare the risk of dementia incidence across patients with AF initiating different OACs. METHODS AND RESULTS: We identified patients with nonvalvular AF initiating OACs in 2 US healthcare claim databases, MarketScan (2007–2015) and Optum Clinformatics (2009–2015). Dementia, comorbidities, and use of medications were defined on the basis of inpatient and outpatient claims. We performed head‐to‐head comparisons of warfarin, dabigatran, rivaroxaban, and apixaban in propensity score–matched cohorts. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) of incident dementia for each propensity score–matched cohort and meta‐analyzed database‐specific results. We analyzed 307 099 patients with AF from the MarketScan database and 161 346 from the Optum database, of which 6572 and 4391, respectively, had a diagnosis of incident dementia. The mean follow‐up of each cohort ranged between 0.7 and 2.2 years. Patients initiating direct OACs experienced lower rates of dementia than those initiating warfarin (dabigatran: HR, 0.85; 95% CI, 0.71–1.01; rivaroxaban: HR, 0.85; 95% CI, 0.76–0.94; apixaban: HR, 0.80; 95% CI, 0.65–0.97). There were no differences in rates of dementia comparing direct OAC user groups (dabigatran versus rivaroxaban: HR, 1.02; 95% CI, 0.79–1.32; dabigatran versus apixaban: HR, 0.92; 95% CI, 0.63–1.36; apixaban versus rivaroxaban: HR, 1.01; 95% CI, 0.86–1.19). CONCLUSIONS: Patients with AF initiating direct OACs experienced lower rates of incident dementia than warfarin users. No obvious benefit was observed for any particular direct OAC in relation to dementia rates. |
format | Online Article Text |
id | pubmed-6404188 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-64041882019-03-18 Association of Oral Anticoagulant Type With Risk of Dementia Among Patients With Nonvalvular Atrial Fibrillation Chen, Nemin Lutsey, Pamela L. MacLehose, Richard F. Claxton, J'Neka S. Norby, Faye L. Chamberlain, Alanna M. Bengtson, Lindsay G. S. O'Neal, Wesley T. Chen, Lin Y. Alonso, Alvaro J Am Heart Assoc Original Research BACKGROUND: Oral anticoagulants (OACs) in patients with atrial fibrillation (AF), in addition to reducing stroke risk, could also prevent adverse cognitive outcomes. The purpose of this study was to compare the risk of dementia incidence across patients with AF initiating different OACs. METHODS AND RESULTS: We identified patients with nonvalvular AF initiating OACs in 2 US healthcare claim databases, MarketScan (2007–2015) and Optum Clinformatics (2009–2015). Dementia, comorbidities, and use of medications were defined on the basis of inpatient and outpatient claims. We performed head‐to‐head comparisons of warfarin, dabigatran, rivaroxaban, and apixaban in propensity score–matched cohorts. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) of incident dementia for each propensity score–matched cohort and meta‐analyzed database‐specific results. We analyzed 307 099 patients with AF from the MarketScan database and 161 346 from the Optum database, of which 6572 and 4391, respectively, had a diagnosis of incident dementia. The mean follow‐up of each cohort ranged between 0.7 and 2.2 years. Patients initiating direct OACs experienced lower rates of dementia than those initiating warfarin (dabigatran: HR, 0.85; 95% CI, 0.71–1.01; rivaroxaban: HR, 0.85; 95% CI, 0.76–0.94; apixaban: HR, 0.80; 95% CI, 0.65–0.97). There were no differences in rates of dementia comparing direct OAC user groups (dabigatran versus rivaroxaban: HR, 1.02; 95% CI, 0.79–1.32; dabigatran versus apixaban: HR, 0.92; 95% CI, 0.63–1.36; apixaban versus rivaroxaban: HR, 1.01; 95% CI, 0.86–1.19). CONCLUSIONS: Patients with AF initiating direct OACs experienced lower rates of incident dementia than warfarin users. No obvious benefit was observed for any particular direct OAC in relation to dementia rates. John Wiley and Sons Inc. 2018-11-02 /pmc/articles/PMC6404188/ /pubmed/30571385 http://dx.doi.org/10.1161/JAHA.118.009561 Text en © 2018 The Authors and Mayo Clinic. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Research Chen, Nemin Lutsey, Pamela L. MacLehose, Richard F. Claxton, J'Neka S. Norby, Faye L. Chamberlain, Alanna M. Bengtson, Lindsay G. S. O'Neal, Wesley T. Chen, Lin Y. Alonso, Alvaro Association of Oral Anticoagulant Type With Risk of Dementia Among Patients With Nonvalvular Atrial Fibrillation |
title | Association of Oral Anticoagulant Type With Risk of Dementia Among Patients With Nonvalvular Atrial Fibrillation |
title_full | Association of Oral Anticoagulant Type With Risk of Dementia Among Patients With Nonvalvular Atrial Fibrillation |
title_fullStr | Association of Oral Anticoagulant Type With Risk of Dementia Among Patients With Nonvalvular Atrial Fibrillation |
title_full_unstemmed | Association of Oral Anticoagulant Type With Risk of Dementia Among Patients With Nonvalvular Atrial Fibrillation |
title_short | Association of Oral Anticoagulant Type With Risk of Dementia Among Patients With Nonvalvular Atrial Fibrillation |
title_sort | association of oral anticoagulant type with risk of dementia among patients with nonvalvular atrial fibrillation |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404188/ https://www.ncbi.nlm.nih.gov/pubmed/30571385 http://dx.doi.org/10.1161/JAHA.118.009561 |
work_keys_str_mv | AT chennemin associationoforalanticoagulanttypewithriskofdementiaamongpatientswithnonvalvularatrialfibrillation AT lutseypamelal associationoforalanticoagulanttypewithriskofdementiaamongpatientswithnonvalvularatrialfibrillation AT maclehoserichardf associationoforalanticoagulanttypewithriskofdementiaamongpatientswithnonvalvularatrialfibrillation AT claxtonjnekas associationoforalanticoagulanttypewithriskofdementiaamongpatientswithnonvalvularatrialfibrillation AT norbyfayel associationoforalanticoagulanttypewithriskofdementiaamongpatientswithnonvalvularatrialfibrillation AT chamberlainalannam associationoforalanticoagulanttypewithriskofdementiaamongpatientswithnonvalvularatrialfibrillation AT bengtsonlindsaygs associationoforalanticoagulanttypewithriskofdementiaamongpatientswithnonvalvularatrialfibrillation AT onealwesleyt associationoforalanticoagulanttypewithriskofdementiaamongpatientswithnonvalvularatrialfibrillation AT chenliny associationoforalanticoagulanttypewithriskofdementiaamongpatientswithnonvalvularatrialfibrillation AT alonsoalvaro associationoforalanticoagulanttypewithriskofdementiaamongpatientswithnonvalvularatrialfibrillation |