Atrial fibrillation as Risk Factor for Development of Cognitive Function Impairment and Dementia. Potential of Anticoagulant Therapy in Their Prevention

Остроумова, О Д; Chernyaeva, M. S.; Головина, О. В.

doi:10.18087/cardio.2018.9.10173

Cited by 8 publications

(1 citation statement)

References 57 publications

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“…Распространенность ФП среди лиц 20 лет и старше составляет 3%, в возрасте 60-69 лет достигает 6%, 70-89 лет -9-14%, а у людей 90 лет и старше это нарушение ритма сердца имеет место в 22% случаев [1,4,5]. Клиническая значимость ФП обусловлена, прежде всего, широким спектром ее осложнений -инсульта, риск которого в данной аритмии возрастает в пять раз [6], сердечной недостаточности, внезапной смерти, в целом сердечно-сосудистой заболеваемости, а также когнитивных нарушений (КН) и деменции [7]. В двух мета-анализах последних [8,9] лет было продемонстрировано, что при ФП риск КН и деменции возрастает в 2,4-2,7 раза, причем, даже при отсутствии в анамнезе инсульта.…”

Section: точка зренияunclassified

Anticoagulant Therapy as a Tool for the Prevention of Cognitive Impairment Associated with Atrial Fibrillation

Остроумова

Кочетков

Korchagina

et al. 2019

Racionalʹnaâ farmakoterapiâ v kardiologii

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Atrial fibrillation (AF) is one of the most common cardiac arrhythmias in clinical practice and important additional risk factor for the development of cognitive impairment (CI) and dementia as it has been shown in recent studies. According to the Diagnostic and statistical manual of mental disorders latest revision CI refers to a decrease of one or more higher cortical functions that provide the processes of perception, storage, transformation and transmission of information compared to the premorbid level. The main hypothesis that explains the relationship between AF and dementia is the assumption that in the presence of this arrhythmia a brain substance is damaged due to microembolism and cerebral microbleeding. The high clinical significance of AF as well as CI served as a background for the development by European experts several consensus documents concerning the problem of the relationships between these conditions. In addition, they emphasize the role of anticoagulant therapy as a preventing tool for the development of stroke, which can be a factor in the CI progression in patients with AF, with particular priority to direct oral anticoagulants (DOACs). In randomized clinical trials, meta-analyses and systematic reviews have been shown that the use of DOACs, as compared to vitamin K antagonists, is a more rational strategy for preventing stroke associated with AF. Among the DOAC class, rivaroxaban is worth noticing as a drug that has a favorable efficacy profile for primary and secondary stroke prevention. Rivaroxaban distinguishing characteristics are a once daily administration as well as a calendar package which is practically important for patients with CI.

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Section: точка зренияunclassified

Anticoagulant Therapy as a Tool for the Prevention of Cognitive Impairment Associated with Atrial Fibrillation

Остроумова

Кочетков

Korchagina

et al. 2019

Racionalʹnaâ farmakoterapiâ v kardiologii

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Vascular factors in the genesis of dementia and the optimization of patient management

Остроумова

Кочетков

2019

RJTAO

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The review considers the problem of cognitive impairment (CI) and dementia in patients from older age groups, as well as the safety of antidementia agents with a focus on adverse cardiovascular drug reactions. Special attention is paid to the role of cardiovascular risk factors in the genesis of CI and all types of dementia. It is emphasized that the treatment of patients with CI is primarily aimed at monitoring vascular risk factors, preventing stroke and progression of chronic cerebrovascular disease, and, therefore, improving cognitive functions. Postoperative cognitive dysfunction in elderly patients, in particular during coronary artery bypass surgery, is highlighted. Non-drug and drug measures to prevent the progression of CI and dementia are described in detail. The significant importance of multimorbidity and polypragmasia in elderly patients with dementia is noted; data on the cardiovascular safety of anti-dementia drugs are presented.

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Drug–drug interaction of rivaroxaban and calcium channel blockers in patients aged 80 years and older with nonvalvular atrial fibrillation

Sychev

Мирзаев

Chernyaeva

et al. 2020

Drug Metabolism and Personalized Therapy

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ObjectivesFor revealing the peculiarities of the drug–drug interaction of rivaroxaban (substrate CYP3A4 and P-gp) and calcium channel blockers (CCBs) (verapamil – inhibitor CYP3A4 and P-gp and amlodipine – substrate CYP3A4) in patients 80 years and older with nonvalvular atrial fibrillation (NAF) we studied 128 patients.MethodsAll patients were divided into groups depending on the therapy taken: the 1st – rivaroxaban + amlodipine (n=51), the 2nd – rivaroxaban + verapamil (n=30), the control group – rivaroxaban without CCBs (n=47). A trough steady-state plasma concentration (Cmin,ss) of rivaroxaban, prothrombin time (PT) in the blood plasma and the event of clinically relevant non-major (CRNM) bleeding were assessed for each patient.ResultsPatient in group 2 had higher Cmin,ss of rivaroxaban, PT and CRNM than subjects in the control group (Me 73.8 [50.6–108.8] ng/mL vs. 40.5 [25.6–74.3] ng/mL; Me 14.8 [13.4–17.3] s vs. 13.8 [12.6–14.4] s; 34% vs. 13%, respectively, p<0.05 for all). When compared, the PT and complication rate in group 1 with the control group Cmin,ss of rivaroxaban were practically the same (p>0.05 for all).ConclusionsIn patients ≥80 years with NAF, the use of rivaroxaban in combination with verapamil may not be safe and can lead to CRNM bleeding.

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Atrial fibrillation as Risk Factor for Development of Cognitive Function Impairment and Dementia. Potential of Anticoagulant Therapy in Their Prevention

Cited by 8 publications

References 57 publications

Anticoagulant Therapy as a Tool for the Prevention of Cognitive Impairment Associated with Atrial Fibrillation

Anticoagulant Therapy as a Tool for the Prevention of Cognitive Impairment Associated with Atrial Fibrillation

Vascular factors in the genesis of dementia and the optimization of patient management

Drug–drug interaction of rivaroxaban and calcium channel blockers in patients aged 80 years and older with nonvalvular atrial fibrillation

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