Oral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: A population-based cohort study

Mongkhon, Pajaree; Fanning, Laura; Lau, Wallis C.Y.; Tse, Gary; Lau, Kui Kai; Wei, Li; Kongkaew, Chuenjid; Wong, Ian Chi Kei

doi:10.1016/j.hrthm.2020.01.007

Cited by 62 publications

(88 citation statements)

References 33 publications

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“…It contains anonymised data from over 744 practices on more than 13 million individuals, covering about 6% of the UK population, and is broadly representative in terms of demographic and health variables [16][17][18]. THIN has information on prescriptions issued by the GPs, which has been widely used to study various conditions including dementia [19,20], and prescribing patterns for different mental health conditions [21][22][23][24][25].…”

Section: Methodology Study Design and Data Sourcementioning

confidence: 99%

Prevalence and Incidence of Dementia in People with Diabetes Mellitus

Alsharif

Wei

et al. 2020

JAD

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Background: Few studies have shown that an increased risk of dementia is associated with diabetes mellitus. Objective: To estimate the prevalence and incidence of dementia in people with diabetes in primary care in the UK. Methods: We conducted a descriptive study using the UK The Health Improvement Network (THIN) database. People diagnosed with diabetes from 2000 to 2016 were included in the study. Prevalence and incidence rates of dementia were calculated annually, stratified by age and gender. Results: The prevalence of dementia was 0.424% [95%CI (0.420%-0.427%)] in 2000 and 2.508% [95% CI (2.501%-2.515%)] in 2016. The highest prevalence was in those aged 85+ from 2.9% [95%CI (2.890%-2.974%)] in 2000 to 11.3% [95% CI (11.285%-11.384%)] in 2016. The incidence of dementia increased 3.7 times, from 0.181 cases per 100 persons [95% CI (0.179-0.183)] in 2000 to 0.683 cases per 100 persons [95%CI (0.679-0.686)] in 2016, respectively. Women had a higher prevalence and incidence of dementia than men 3.138% [95% CI (3.127%-3.150%)] vs 2.014% [95% CI (2.006%-2.022%)] and 0.820 [95% CI (0.814-0.826)] vs 0.576 cases per 100 persons [95%CI (0.571-0.580)] in 2016, respectively. Conclusion: There was a trend of increasing prevalence and incidence of dementia in people with diabetes over the period of 2000 to 2016. This study adds to the evidence on dementia prevalence and incidence, particularly in the diabetic population.

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Section: Methodology Study Design and Data Sourcementioning

confidence: 99%

Prevalence and Incidence of Dementia in People with Diabetes Mellitus

Alsharif

Wei

et al. 2020

JAD

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“…The diagnosis data within THIN is recorded by general practitioners using the Read classification system 15 . The quality of THIN data has been validated 16 and diagnosis and prescribing information have been used in previous dementia and anticoagulant studies 17–21 . The protocol for this study was approved by the THIN Scientific Review Committee (reference number 18THIN043).…”

Section: Methodsmentioning

confidence: 99%

Patterns and factors influencing oral anticoagulant prescription in people with atrial fibrillation and dementia: Results from UK primary care

Mongkhon

Alwafi

Fanning

et al. 2020

Brit J Clinical Pharma

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Aims Oral anticoagulant (OAC) is recommended for preventing stroke in atrial fibrillation (AF). However, the OAC utilisation in AF patients with dementia or cognitive impairment (CI) is limited. This study aimed to examine the prevalence of OAC prescriptions in AF patients with dementia/CI and to identify factors associated with OAC treatment within 180 days after dementia/CI diagnosis. Methods Using The Health Improvement Network database, the annual trends of OAC between 2000 and 2015 were calculated. Multivariable logistic regression was performed to identify factors associated with OAC treatment. Results The prevalence rate of OAC prescriptions increased from 6.1% in 2000 to 45.9% in 2015. Among OAC users, the proportion of direct oral anticoagulants (DOACs) use increased significantly from 0.1% in 2011 to 33.8% in 2015 (P‐trend < 0.001), while the proportion of vitamin K antagonist use decreased by 28.6% from 100% in 2000 to 71.4% in 2015 (P‐trend < 0.001). In the multivariable analysis, younger age, very old age, female sex, higher Charlson Comorbidity Index, having a HAS‐BLED score ≥3, a history of intracranial bleeding, falls and polypharmacy were significantly associated with lower odds of receiving OAC. Conclusions In UK primary care, OAC use increased from 2000 to 2015 in AF patients with dementia/CI, with a substantial increase in use of DOACs. Characteristics related to frailty are associated with lower odds of OAC prescription. Given the increasing use of DOACs in patients with dementia/CI, further studies are needed to investigate the safety and effectiveness of DOACs in this important patient group.

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“…In accordance, a retrospective registry study in Sweden (2006–2014) on more than 400,000 patients with atrial fibrillation yielded a considerably lower risk of dementia after treatment with DOACs or the VKA warfarin [ 115 ]. Likewise, association between oral anticoagulant use and a lower risk of dementia was demonstrated in a retrospective cohort study (2000–2017; based on UK primary care data) in participants with newly diagnosed atrial fibrillation without incidence of dementia [ 116 ]. Furthermore, a retrospective clinical study (2010–2014) was carried out in more than 5000 elderly patients with atrial fibrillation, who received long-term anticoagulation with DOACs (apixaban, dabigatran, rivaroxaban), in comparison to warfarin [ 117 ].…”

Section: Alzheimer’s Disease and Other Brain Amyloidosis—outlook For Therapeutic Use Of Dabigatranmentioning

confidence: 99%

Alzheimer’s Disease—Rationales for Potential Treatment with the Thrombin Inhibitor Dabigatran

Großmann

2021

IJMS

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Alzheimer’s disease (AD) is caused by neurodegenerative, but also vascular and hemostatic changes in the brain. The oral thrombin inhibitor dabigatran, which has been used for over a decade in preventing thromboembolism and has a well-known pharmacokinetic, safety and antidote profile, can be an option to treat vascular dysfunction in early AD, a condition known as cerebral amyloid angiopathy (CAA). Recent results have revealed that amyloid-β proteins (Aβ), thrombin and fibrin play a crucial role in triggering vascular and parenchymal brain abnormalities in CAA. Dabigatran blocks soluble thrombin, thrombin-mediated formation of fibrin and Aβ-containing fibrin clots. These clots are deposited in brain parenchyma and blood vessels in areas of CAA. Fibrin-Aβ deposition causes microvascular constriction, occlusion and hemorrhage, leading to vascular and blood–brain barrier dysfunction. As a result, blood flow, perfusion and oxygen and nutrient supply are chronically reduced, mainly in hippocampal and neocortical brain areas. Dabigatran has the potential to preserve perfusion and oxygen delivery to the brain, and to prevent parenchymal Aβ-, thrombin- and fibrin-triggered inflammatory and neurodegenerative processes, leading to synapse and neuron death, and cognitive decline. Beneficial effects of dabigatran on CAA and AD have recently been shown in preclinical studies and in retrospective observer studies on patients. Therefore, clinical studies are warranted, in order to possibly expand dabigatran approval for repositioning for AD treatment.

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Oral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: A population-based cohort study

Cited by 62 publications

References 33 publications

Prevalence and Incidence of Dementia in People with Diabetes Mellitus

Prevalence and Incidence of Dementia in People with Diabetes Mellitus

Patterns and factors influencing oral anticoagulant prescription in people with atrial fibrillation and dementia: Results from UK primary care

Alzheimer’s Disease—Rationales for Potential Treatment with the Thrombin Inhibitor Dabigatran

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