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Treatment of Atrial Fibrillation in Patients with Dementia: A Cohort Study from the Swedish Dementia Registry
Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
National Institute of Mental Health, Klecany, Czech Republic.
Polish Academy of Sciences, Mossakowski Medical Research Center, Warsaw, Poland.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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2018 (English)In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 61, no 3, p. 1119-1128Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Patients with dementia might have higher risk for hemorrhagic complications with anticoagulant therapy prescribed for atrial fibrillation (AF).

OBJECTIVE: This study assesses the risks and benefits of warfarin, antiplatelets, and no treatment in patients with dementia and AF.

METHODS: Of 49,792 patients registered in the Swedish Dementia Registry 2007-2014, 8,096 (16%) had a previous diagnosis of AF. Cox proportional hazards models were used to calculate the risk for ischemic stroke (IS), nontraumatic intracranial hemorrhage, any-cause hemorrhage, and death.

RESULTS: Out of the 8,096 dementia patients with AF, 2,143 (26%) received warfarin treatment, 2,975 (37%) antiplatelet treatment, and 2,978 (37%) had no antithrombotic treatment at the time of dementia diagnosis. Patients on warfarin had fewer IS than those without treatment (5.2% versus 8.7%; p < 0.001) with no differences compared to antiplatelets. In adjusted analyses, warfarin was associated with a lower risk for IS (HR 0.76, CI 0.59-0.98), while antiplatelets were associated with increased risk (HR 1.25, CI 1.01-1.54) compared to no treatment. For any-cause hemorrhage, there was a higher risk with warfarin (HR 1.28, CI 1.03-1.59) compared to antiplatelets. Warfarin and antiplatelets were associated with a lower risk for death compared to no treatment.

CONCLUSIONS: Warfarin treatment in Swedish patients with dementia is associated with lower risk of IS and mortality, and a small increase in any-cause hemorrhage. This study supports the use of warfarin in appropriate cases in patients with dementia. The low percentage of patients on warfarin treatment indicates that further gains in stroke prevention are possible.

Place, publisher, year, edition, pages
IOS Press, 2018. Vol. 61, no 3, p. 1119-1128
Keyword [en]
Atrial fibrillation, dementia, hemorrhage, ischemic stroke, warfarin
National Category
Neurology Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:hj:diva-38764DOI: 10.3233/JAD-170575ISI: 000422845200025PubMedID: 29286925Local ID: HHJARNISOAI: oai:DiVA.org:hj-38764DiVA: diva2:1181021
Available from: 2018-02-07 Created: 2018-02-07 Last updated: 2018-02-07Bibliographically approved

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