Anticoagulants Can Ease Cognitive Decline in AF Patients

 | Post date: 2021/11/27 | 

Atrial fibrillation is the most common sustained cardiac rhythm disturbance seen in clinical practice. A number of trials have shown that the condition, which is most prevalent among the elderly, increases the chance of cerebrovascular accidents and of blood clots forming in the heart, increasing total mortality. These aspects are well-established, as is the use of anticoagulants to prevent thromboembolism in individuals with relevant risk scores. Yet although previous research has looked at the association between atrial fibrillation and cognitive decline, no studies to date have explored the effects of oral anticoagulants on the cognitive and functional aspects of patients.

But a Brazilian trial that brings to light the significant effects of anticoagulants on brain health was recently presented at the American Heart Association Scientific Sessions 2021.

The Cognitive Impairment Related to Atrial Fibrillation (GIRAF) study evaluated the effects of the anticoagulants warfarin and dabigatran on cognitive and functional impairment, bleeding occurrence, and cerebrovascular complications. It was led by cardiologist Bruno Caramelli, MD, PhD, associate professor and director of the interdisciplinary medicine in cardiology unit at the Heart Institute (InCor) of the University of São Paulo School of Medicine Clinics Hospital.

"There was no difference between the patients in the dabigatran group and the patients in the warfarin group," he told Medscape Medical News.

The adequate use of anticoagulants can prevent cognitive decline in elderly patients with atrial fibrillation, Caramelli and his colleagues determined after 2 years of follow-up. This conclusion is based on data obtained from scales that measure memory, executive function, language, and attention. All participants completed a series of 90-minute cognitive and functional evaluations at baseline and during follow-up visits. Patients also underwent a brain MRI at baseline and after 2 years to identify possible stroke.

"There was no control group, as it would have been unethical to provide inadequate or incomplete treatment. That's why I can't say for certain that, if well treated, patients won't develop cognitive decline. On the other hand, using historic control data from previous studies allows us to make this inference, which, while speculative, has a good chance of being correct," Caramelli said.

The randomized, multicenter, prospective GIRAF trial evaluated 200 patients (62% male) older than 70 years with confirmed atrial fibrillation. Participants were randomly assigned to a 2-year course of dabigatran 110 mg or 150 mg twice daily, or to warfarin once daily at a dose sufficient to clot the blood. Most were treated at public hospitals in Brazil's Unified Healthcare System.

When designing the study, the investigators were concerned whether they would find tools sensitive enough to assess higher cognitive function.

Cite this: Anticoagulants Can Ease Cognitive Decline in AF Patients - Medscape - Nov 25, 2021.




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