Warfarin Versus Aspirin for Prevention of Cognitive Decline in Atrial Fibrillation

Abstract

Therefore, it can be inferred that anticoagulation reduces risk of cognitive decline in AF by preventing overt strokes. What is not known is whether anticoagulation reduces the risk of cognitive decline in AF through any other mechanism, such as by reducing the risk of silent stroke. The aim of this analysis is to compare the efficacy of warfarin with aspirin for prevention of cognitive decline in a primary care population of Background and Purpose-Atrial fibrillation is associated with decline of cognitive function. Observational evidence suggests that anticoagulation might protect against this decline. We report the first randomized controlled trial evidence on the effect of anticoagulation on cognitive function in elderly patients with atrial fibrillation. Methods-A total of 973 patients aged ≥75 years with atrial fibrillation were recruited from primary care and randomly assigned to warfarin (n=488; target international normalized ratio, 2-3) or aspirin (n=485; 75 mg/d). Neither participants nor investigators were masked to group assignment. Follow-up was for a mean of 2.7 years (SD, 1.2). Cognitive outcome was assessed using the Mini-Mental State Examination at 9-, 21-, and 33-month follow-up. Participants who had a stroke were censored from the analysis, which was by intention to treat with imputation for missing data. Results-There was no difference between mean Mini-Mental State Examination scores in people assigned to warfarin or aspirin at 9 or 21 months. At 33-month follow-up, there was a nonsignificant difference of 0.56 in favor of warfarin that decreased to 0.49 (95% confidence interval, -0.01 to 0.98) after imputation. Conclusions-We

Links between parameters of long-term latent memory and progression from paroxysmal to permanent atrial fibrillation during a five-year observation period. A preliminary study

“…This may be recognised as a practical contribution of our study. Cognitive impairment and silent brain injury may also be suggested as a guide for prescribing anticoagulation treatment for patients at low risk of AF to prevent cognitive decline [11,17].…”

“…The following pathomechanisms of the relationships between AF and cognitive impairment have been suggested: (a) stroke due to embolus of a cerebral artery; (b) asymptomatic cerebral artery microembolism with mate-rial of cardiac origin, e.g. due to insufficient anticoagulation; (c) haemodynamic complications of atrial arrhythmia leading to a decrease in cerebral blood flow; (d) anticoagulation complications with haemorrhagic stroke; (e) systolic or diastolic cardiac failure; and (f) the effect of characteristics and comorbidities leading to heart and vascular injury, such as: increased age, gender, hypertension, diabetes mellitus, hyperlipidaemia, obesity, low physical activity, and systemic inflammatory status [10,[13][14][15][16][17][18]. Relationships between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and left atrium dilatation are also reported [19][20][21].…”

Thromboprophylaxis in atrial fibrillation and association with cognitive decline: systematic review

“…(Figure 1) Of these, 19 studies (n=15,876 participants) were suitable for inclusion [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] (five were extended abstracts, supplemented, where possible, by additional data from authors [23][24][25][26][27]). (Table 1) The internal validity of title searching process was confirmed as no titles from focused review were missed in the full review.…”

“…(Table 1) Of five RCTs identified, only one had cognitive data suited to our proposed analysis. [11] In this study, the Birmingham Atrial Fibrillation Treatment of the Aged (BAFTA) study, older adults were randomised to warfarin (target International Events (ACTIVE-W) study reported association between time in therapeutic range and cognitive scores but did not provide cognitive scores by treatment arm. [13] Similarly, a single-centre study of warfarin versus aspirin provided only aggregate cognitive data.…”

Anticoagulation for Chronic Non Valvular Atrial Fibrillation in the Elderly: A Review

“…Atrial fibrillation is independently associated with cognitive dysfunction, with increased thrombin generation and fibrin turnover, with higher D-dimer, prothrombin fragment 1+2 and thrombin-anti-thrombin comlexes were reported in patients with dementia and FA when compared with patients with only FA [30]. However, it has been reported that anticoagulation was no better than aspirin in protecting against cognitive decline as measured by the mini-mental score, other than that provided by preventing clinical stroke [31]. However, with proper instruction to the patient or carer, mild to moderate cognitive dysfunction does not delay the time required to achieve therapeutic anticoagulation nor decreased anticoagulation stability in terms of number of clinic visits compared with patients with normal cognitive function [32].…”