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Vol. 73. Issue 11.
Pages 877-884 (November 2020)
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Vol. 73. Issue 11.
Pages 877-884 (November 2020)
Original article
DOI: 10.1016/j.rec.2019.10.025
Impact of anticoagulation in patients with dementia and atrial fibrillation. Results of the CardioCHUVI-FA registry
Impacto de la anticoagulación en los pacientes con demencia y fibrilación auricular. Resultados del registro CardioCHUVI-FA
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Rafael Cobas Paza,
Corresponding author
rafacobaspaz@gmail.com

Corresponding author: Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Estrada Clara Campoamor 341, 36212 Vigo, Pontevedra, Spain.
, Sergio Raposeiras Roubína, Emad Abu Assia, Cristina Barreiro Pardalb, Julio García Comesañac, Alberto González-Carrero Lópezd, Berenice Caneiro Queijaa, María Cespón Fernándeza, Isabel Muñoz Pousaa, Pablo Domínguez Erquiciaa, Luis Manuel Domínguez Rodrígueza, Alberto Carpintero Varae, Enrique García Campoa, Carlos Rodríguez Pascuale, Andrés Íñiguez Romoa
a Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
b Servicio de Anestesia, Hospital Universitario Montecelo, Pontevedra, Spain
c Gerencia, Hospital Universitario de Orense, Orense, Spain
d Servicio de Admisión Hospitalaria, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
e Servicio de Geriatría, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
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Figures (2)
Tables (3)
Table 1. Differences in baseline, test result, echocardiographic, and medical therapy characteristics between patients aged ≥ 85 years with and without dementia.
Table 2. Baseline, test result, echocardiographic, and medical therapy characteristics of patients aged ≥ 85 years with dementia treated with and without anticoagulation. Results before and after propensity score matching
Table 3. Differences in the baseline characteristics of the patients with dementia according to event (mortality, embolisms, and bleeding)
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Additional material (1)
Abstract
Introduction and objectives

Population aging is associated with an increased prevalence of atrial fibrillation (AF) and dementia. This study aimed to analyze the impact of oral anticoagulation in elderly patients with AF and moderate-severe dementia.

Methods

We conducted a single-center retrospective study analyzing patients aged ≥ 85 years with a diagnosis of AF between 2013 and 2018. The impact of anticoagulation on mortality, embolisms, and bleeding events was assessed by multivariate Cox analysis. In patients with dementia, this analysis was complemented by propensity score matching, depending on whether the patients were prescribed anticoagulant treatment or not.

Results

Of the 3549 patients aged ≥ 85 years with AF, 221 had moderate-severe dementia (6.1%), of whom 88 (60.2%) were anticoagulated. During a follow-up of 2.8 ±1.7 years, anticoagulation was associated with lower embolic risk and higher bleeding risk both in patients with dementia (hazard ratio [HR]embolisms, 0.36; 95%CI, 0.15-0.84; HRbleeding, 2.44; 95%CI, 1.04-5.71) and in those without dementia (HRembolisms, 0.58; 95%CI, 0.45-0.74; HRbleeding, 1.55, 95%CI, 1.21-1.98). However, anticoagulation was associated with lower mortality only in patients without dementia (HR, 0.63; 95%CI, 0.53-0.75) and not in those with dementia (adjusted HR, 1.04; 95%CI, 0.63-1.72; P=.541; HR after propensity score matching 0.91, 95%CI, 0.45-1.83; P=.785).

Conclusions

In patients aged ≥ 85 years with moderate-severe dementia and AF, oral anticoagulation was significantly associated with a lower embolic risk and a higher bleeding risk, with no differences in total mortality.

Keywords:
Atrial fibrillation
Dementia
Oral anticoagulation
Bleeding
Embolisms
Abbreviations:
AF
DOACs
VKAs
Resumen
Introducción y objetivos

El envejecimiento de la población se asocia con una prevalencia creciente de fibrilación auricular (FA) y demencia. Con este estudio se pretende analizar el impacto de la anticoagulación oral en pacientes ancianos con FA y demencia de grado moderado-grave.

Métodos

Estudio retrospectivo unicéntrico que analiza a pacientes de edad ≥ 85 años con diagnóstico de FA entre 2013 y 2018. El impacto de la anticoagulación en la mortalidad, las embolias y las hemorragias se evaluó mediante un análisis multivariado de Cox. En los pacientes con demencia, dicho análisis se complementó con un propensity score matching en función de que se les prescribiera tratamiento anticoagulante o no.

Resultados

De los 3.549 pacientes de 85 o más años con FA, 221 presentaban demencia de grado moderado-grave (6,1%), de los que 88 (60,2%) fueron anticoagulados. Durante un seguimiento de 2,8 ±1,7 años, la anticoagulación se asoció con menor riesgo embólico y mayor riesgo hemorrágico tanto en pacientes con demencia (HRembolias=0,36; IC95%, 0,15-0,84; HRhemorragias=2,44; IC95%, 1,04-5,71) como sin demencia (HRembolias=0,58; IC95%, 0,45-0,74; HRhemorragias=1,55; IC95%, 1,21-1,98). Sin embargo, la anticoagulación únicamente se asoció con menor mortalidad en los pacientes sin demencia (HR=0,63; IC95%, 0,53-0,75), no en pacientes con demencia (HR ajustada=1,04; IC95%, 0,63-1,72; p=0,541; HR después de propensity score matching=0,91; IC95%, 0,45-1,83; p=0,785).

Conclusiones

En pacientes de 85 o más años con demencia moderada-grave y FA, la anticoagulación oral se asoció de manera significativa con menor riesgo de embolias y mayor riesgo hemorrágico, sin encontrarse diferencias en cuanto a mortalidad total.

Palabras clave:
Fibrilación auricular
Demencia
Anticoagulación oral
Hemorragias
Embolias

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