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  • Protective effects of oral anticoagulants on cerebrovascular diseases and cognitive impairment in patients with atrial fibrillation: protocol for a multicentre, prospective, observational, longitudinal cohort study (Strawberry study)

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Neurology
Protocol
Protective effects of oral anticoagulants on cerebrovascular diseases and cognitive impairment in patients with atrial fibrillation: protocol for a multicentre, prospective, observational, longitudinal cohort study (Strawberry study)
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  • Published on: 6 May 2020
    RE: Protective effects of oral anticoagulants on cerebrovascular diseases and cognitive impairment in patients with atrial fibrillation

    Saji et al. intended a prospective study to know the effects of warfarin therapy and direct oral anticoagulants (DOACs) on cerebrovascular diseases and cognitive impairment (CI) in patients with non-valvular atrial fibrillation (NVAF) over an estimated duration of 36 months (1). I want to present some information.

    First, Mongkhon et al. investigated the risk of dementia/CI among newly diagnosed atrial fibrillation (AF) patients with and without oral anticoagulation (OAC) treatment over a mean follow-up of 5.9 years (2). Hazard ratios (HRs) (95% confidence intervals [CIs) of OAC treatment and antiplatelets for dementia/CI were 0.90 (0.85-0.95) and 0.84 (0.79-0.90), respectively. In contrast, HR (95% CI) of DOACs treatment against warfarin for dementia/CI was 0.89 (0.70-1.14). Furthermore, HR (95% CI) of dual therapy (OAC plus antiplatelets) for dementia/CI was 1.17 (1.05-1.31). Saji et al. set two clinical outcomes, and study period was shorter. In addition, safety evaluation on bleeding might also be required.

    Second, Diener et al. recommended randomized trials to evaluate whether OAC, including warfarin and DOACs, reduces dementia/CI in AF patients (3). Dementia/CI, including vascular dementia and Alzheimer's disease, might be related to ischemic stroke, cerebral micro-infarcts, cerebral hemorrhage, and reduced cerebral blood flow. Taken together, risk assessment of medications for dementia/CI in AF patients would be closely associated with types of cer...

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    Conflict of Interest:
    None declared.
  • Published on: 27 April 2020
    RE: Protective effects of oral anticoagulants on cerebrovascular diseases and cognitive impairment in patients with atrial fibrillation

    Saji et al. intended a prospective study to know the effects of warfarin therapy and direct oral anticoagulants (DOACs) on cerebrovascular diseases and cognitive impairment (CI) in patients with non-valvular atrial fibrillation (NVAF) over an estimated duration of 36 months (1). I want to present some information.

    First, Mongkhon et al. investigated the risk of dementia/CI among newly diagnosed atrial fibrillation (AF) patients with and without oral anticoagulation (OAC) treatment over a mean follow-up of 5.9 years (2). Hazard ratios (HRs) (95% confidence intervals [CIs) of OAC treatment and antiplatelets for dementia/CI were 0.90 (0.85-0.95) and 0.84 (0.79-0.90), respectively. In contrast, HR (95% CI) of DOACs treatment against warfarin for dementia/CI was 0.89 (0.70-1.14). Furthermore, HR (95% CI) of dual therapy (OAC plus antiplatelets) for dementia/CI was 1.17 (1.05-1.31). Saji et al. set two clinical outcomes, and study period was shorter. In addition, safety evaluation on bleeding might also be required.

    Second, Diener et al. recommended randomized trials to evaluate whether OAC, including warfarin and DOACs, reduces dementia/CI in AF patients (3). Dementia/CI, including vascular dementia and Alzheimer's disease, might be related to ischemic stroke, cerebral micro-infarcts, cerebral hemorrhage, and reduced cerebral blood flow. Taken together, risk assessment of medications for dementia/CI in AF patients would be closely associated with types of cer...

    Show More
    Conflict of Interest:
    None declared.