Continued Use of Warfarin in Veterans with Atrial Fibrillation After Dementia Diagnosis

Abstract

Discontinuing warfarin after a diagnosis of dementia is associated with a significant increase in stroke and mortality.

Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence

“…After diagnosis of dementia, only 16% of patients persisted on warfarin therapy. Using propensity score matching, the protective effect of continuing warfarin persisted in stroke prevention (HR 0.74; 95% CI 0.54-0.996, p 0.047) and mortality (HR 0.72; 95% CI 0.60-0.87, p b 0.001), with no statistically significant decrease in risk of major bleedings (HR 0.78; 95% CI 0.61-1.01, p 0.06), suggesting that warfarin discontinuation after a diagnosis of dementia is associated with a significant increase in stroke and mortality [32].…”

“…Moreover, the natural history of individuals with AF taking warfarin who subsequently develop dementia is not well understood. A recent retrospective cohort study in 2572 Veterans ≥ 65 years (73% aged ≥ 75) investigated the effectiveness of warfarin in older patients with AF and dementia [32]. Patients who had been receiving warfarin for nonvalvular AF for at least 6 months and who were newly diagnosed with dementia were followed to assess the incidence of ischemic stroke, major bleedings and overall mortality.…”

Arrhythmias in Patients ≥80 Years of Age

“…However, in a recent study of veterans (mean age 80 years) with AF, continuation of warfarin after a diagnosis of dementia was associated with a reduction of stroke and mortality, without an increase in major bleeding (66). …”

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: What is the best practice?

“…Since a prior stroke represents the strongest predictor of stroke recurrence, all patients who have AF and have had an ischaemic stroke should be anticoagulated, unless an absolute contraindication exists . Of interest, a recent observational study using a propensity score‐matched analysis reported that in individuals with a history of AF and dementia, persistent use of warfarin therapy was uncommon (16%), but was associated with the prevention of stroke [hazard ratio (HR) HR 0.74, 95% CI: 0.54‐0.996; P = .047] and death (HR 0.72, 95% CI: 0.67‐0.87; P < .001) . A recent updated meta‐analysis reported a significant reduction of stroke, stroke or systemic embolism, haemorrhagic stroke, and intracranial bleeding in AF patients with previous stroke or transient ischaemic attack (TIA) receiving NOACs compared with warfarin …”