Prevalence of oral anticoagulant use among people with and without Alzheimer’s disease

Abstract

Background Although cardio- and cerebrovascular diseases are common among people with Alzheimer’s disease (AD), it is unknown how the prevalence of oral anticoagulant (OAC) use changes in relation to AD diagnosis. We investigated the prevalence of OAC use in relation to AD diagnosis in comparison to a matched cohort without AD. Methods Register-based Medication use and Alzheimer’s disease (MEDALZ) cohort includes 70 718 Finnish people with AD diagnosed between 2005–2011. Point prevalence of OAC use (prescription register) was calculated every three months with three-month evaluation periods, from five years before to five years after clinically verified diagnosis and compared to matched cohort without AD. Longitudinal association between AD and OAC use was evaluated by generalized estimating equations (GEE). Results OAC use was more common among people with AD until AD diagnosis, (OR 1.17; 95% CI 1.13–1.22), and less common after AD diagnosis (OR 0.87; 95% CI 0.85–0.89), compared to people without AD. At the time of AD diagnosis, prevalence was 23% and 20% among people with and without AD, respectively. OAC use among people with AD began to decline gradually two years after AD diagnosis while continuous increase was observed in the comparison cohort. Warfarin was the most common OAC, and atrial fibrillation was the most common comorbidity in OAC users. Conclusion Decline in OAC use among people with AD after diagnosis may be attributed to high risk of falling and problems in monitoring. However, direct oral anticoagulants (DOACs) that are nowadays more commonly used require less monitoring and may also be safer for vulnerable people with AD.

Cellular mechanisms of fibrin (ogen): insight from neurodegenerative diseases

“…However, it is important to acknowledge that simply lowering plasma fibrinogen levels may interfere with the crucial role of fibrinogen in coagulation function, consequently increasing the risk of hemorrhagic disorders. An epidemiological survey investigating the use of oral anticoagulants in patients with AD and non-AD patients revealed a gradual decrease in the proportion of patients utilizing oral anticoagulants 2 years after an AD diagnosis, potentially influenced by factors such as the heightened risk of falls in patients ( Ali Babar et al, 2022 ). Particularly in elderly patients, AD brains are prone to hemorrhage due to the presence of cerebral amyloid angiopathy (CAA) ( Thal et al, 2008 ; Smith and Greenberg, 2009 ; Attems et al, 2011 ).…”

Discontinuation of oral anticoagulant use among nursing home residents with atrial fibrillation before hospice enrollment

“…Indeed, we found that intermediate or high bleeding risk predicted by the ATRIA risk score was associated with a significantly higher prevalence of OAC discontinuation before hospice enrollment. Prior research suggests potential contributing factors to OAC discontinuation among the older‐old, those with cognitive impairment, and those with functional limitations include concerns regarding fall risk and subsequent bleeding 35–37 …”

“…Prior research suggests potential contributing factors to OAC discontinuation among the older-old, those with cognitive impairment, and those with functional limitations include concerns regarding fall risk and subsequent bleeding. [35][36][37] More than 40% of nursing home residents who discontinued OACs before hospice enrollment had mild cognitive impairment or were cognitively intact. The decision to use OACs to prevent an ischemic stroke has the potential to meaningfully preserve functioning, cognition, and quality of life.…”

Antiplatelet drugs: Potential therapeutic options for the management of neurodegenerative diseases

“…Hence, direct oral anticoagulants (DOACs), which are more often used now, require less monitoring and might even be safer for AD patients who are more susceptible to AD complications. 133 Furthermore, treatment with warfarin (a vitamin K inhibitor) or rivaroxaban (a Factor Xa blocker) decreased the maximal EAE score compared with the control group and decreased inflammatory lesions in the spinal cord in SJL/J EAE mice. Hence, warfarin and rivaroxaban anticoagulation dual therapy could potentially improve MS complications.…”

“…In a recent study, Babar et al reported a significant risk of falling issues that may result from the decline in oral anticoagulant use among AD patients after diagnosis. Hence, direct oral anticoagulants (DOACs), which are more often used now, require less monitoring and might even be safer for AD patients who are more susceptible to AD complications 133 . Furthermore, treatment with warfarin (a vitamin K inhibitor) or rivaroxaban (a Factor Xa blocker) decreased the maximal EAE score compared with the control group and decreased inflammatory lesions in the spinal cord in SJL/J EAE mice.…”