anticoagulants and dementia in patients with atrial fibrillation

Atrial fibrillation is the most common rhythm change we see, and the risk of developing it increases with age, such that the lifetime risk is estimated to be around 37% for people aged 55 and above.

The most significant risk that atrial fibrillation (AF) presents is the risk of stroke; the irregular heart beat predisposes to clot formation within the heart, and if a clot enters the general circulation it can lodge in one of the arteries leading to the brain, causing a stroke. Doctors use a scoring system called the CHA2DS2-VASc score to determine who should be offered an anticoagulant to thin the blood and thereby reduce this risk (more information on this can be found by clicking on this link).

Until fairly recently patients were offered warfarin to thin the blood, but this requires regular blood tests and also has important interactions with food and drink, which can make it difficult to maintain a level of blood thinning which reduces stroke risk but does not excessively increase the risk of bleeding. The class of drug known as the DOACs (direct oral anticoagulant), which includes dabigatran, rivaroxaban, apixaban and edoxaban, does not require monitoring in the same way and is the drug class of choice in many (but not all) patients with atrial fibrillation.

In addition to the already well documented benefits of DOACs, recent research published in Heart, the Journal of the British Cardiovascular Society, found that the incidence of dementia and mild cognitive impairment was found to be lower in patients prescribed a DOAC for new atrial fibrillation, compared to those prescribed warfarin. Given that our population is growing and that people are longer-lived than in previous times, plus the lack of effective treatment for dementia once symptoms present, prevention of dementia is becoming an increasingly important issue, making this research highly relevant.

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