Long-term cognitive function changes with non-vitamin K oral anticoagulants in older patients with atrial fibrillation. A multicenter cohort study.

IF 4.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Giuseppe Armentaro, Graziella D'Arrigo, Daniele Pastori, Giulia Crudo, Mario Daidone, Luca Soraci, Carlo Alberto Pastura, Marcello Divino, Annalisa Pitino, Mercedes Gori, Giovanni Tripepi, Egidio Imbalzano, Andrea Corsonello, Pasquale Pignatelli, Francesco Andreozzi, Antonino Tuttolomondo, Angela Sciacqua
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引用次数: 0

Abstract

Background: Atrial fibrillation is associated with several comorbidities, particularly cognitive impairment and dementia, especially in older patients. Non-vitamin K oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) were used to prevent thromboembolic events. However, data on the real benefit of these drugs on cognitive function decline remains controversial. In this study we evaluated the effect of NOACs compared to VKAs on the absolute and relative decline in cognitive function over time.

Methods: Nine hundred and eighty-three older patients with nonvalvular AF were enrolled (76 ± 6 years; 291 on VKAs and 692 on NOACs). The cognitive function was assessed with Mini Mental State examination (MMSE) score. The between-arms difference of cognitive evolution over time was investigated by Linear Mixed Models and group-based trajectory model analyses.

Results: In the whole multicenter observational study, after a long follow-up of 7.2 ± 3.4 years, the patients of the NOACs versus VKAs group had lowest absolute reduction of the MMSE score between baseline and follow-up (-0.3 ± 0.03 vs.-1.7 ± 0.1, p < 0.001). After stratification into five subgroups according to trajectories of MMSE score over time, the probability to belong to trajectories with lower decline in cognitive functions was higher in patients on NOACs than in those on VKAs (3.93-13.88 times).

Conclusion: In older patients with atrial fibrillation, the use of NOACs was associated with a smaller decline of cognitive function over time compared to the VKAs, regardless that patients in the NOACs group were older and with a higher burden of comorbidities.

老年心房颤动患者服用非维生素 K 口服抗凝剂后认知功能的长期变化。一项多中心队列研究。
背景:心房颤动与多种合并症有关,特别是认知障碍和痴呆,尤其是在老年患者中。非维生素 K 口服抗凝剂(NOACs)或维生素 K 拮抗剂(VKAs)被用于预防血栓栓塞事件。然而,关于这些药物对认知功能下降的真正益处的数据仍存在争议。在这项研究中,我们评估了 NOAC 与 VKAs 相比对认知功能随时间的绝对和相对下降的影响:共纳入 983 名老年非瓣膜性房颤患者(76 ± 6 岁;291 人服用 VKA,692 人服用 NOAC)。认知功能通过迷你精神状态检查(MMSE)评分进行评估。通过线性混合模型和基于组别的轨迹模型分析,研究了各组间认知功能随时间演变的差异:在整个多中心观察研究中,经过 7.2 ± 3.4 年的长期随访,NOACs 组与 VKAs 组患者的 MMSE 评分在基线与随访之间的绝对值降幅最小(-0.3 ± 0.03 vs.-1.7 ± 0.1,P 结论:NOACs 组与 VKAs 组患者的 MMSE 评分在基线与随访之间的绝对值降幅最小:在老年心房颤动患者中,使用 NOACs 与 VKAs 相比,随着时间的推移,认知功能的下降幅度较小,尽管 NOACs 组患者年龄较大,合并症较多。
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来源期刊
CiteScore
9.50
自引率
3.60%
发文量
192
审稿时长
1 months
期刊介绍: EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.
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