Anticoagulation in atrial fibrillation and cognitive decline: A systematic review and meta-analysis

BACKGROUND: It is well known that atrial fibrillation (AF) carried a high risk of cognitive decline, which is independent of stroke or transient ischemic attack (TIA). Whether anticoagulation is associated with reduced risk of cognitive decline in participants with AF still remains controversial. We conducted a systematic review and meta-analysis to explore the effect of anticoagulation on the risk of cognitive decline in patients with AF. METHODS: We systematically searched the PubMed, Embase and the Cochrane Database for eligible studies published up to January 2018. Risk ratios (RR) with 95% confidence interval (CI) for cognitive decline were extracted, and pooled estimations were calculated using the fixed effects model. Subgroup analyses were further performed. RESULTS: Eight relevant articles involved 454,273 patients were ultimately included in this meta-analysis. We found that anticoagulation was associated with reduced risk of cognitive impairment as compared with nonanticoagulation (RR 0.72, 95% CI 0.69–0.75, I(2) 11.5%). This reduction was still significant after adjustment for stroke and TIA (RR 0.72, 95% CI 0.69–0.74, I(2) 0.0%). In the subgroup analyses, the incidence of cognitive decline was significantly decreased in those treated with anticoagulation compared to no treatment (RR 0.72, 95% CI 0.69–0.75, I(2) 0.0%), but the cognitive benefit showed no significant difference between anticoagulant and antiplatelet treatment (RR 1.01, 95% CI 0.68–1.50, I(2) 46.8%). CONCLUSION: Anticoagulation is associated with cognitive benefit in participants with AF independent of stroke and TIA, but it was not superior to antiplatelet drugs in reducing the risk of cognitive decline.