Continuing Warfarin in Nonvalvular Atrial Fibrillation With Dementia
Researchers studied 2572 veterans aged 65 years and older who had been receiving warfarin for nonvalvular afib.
HealthDay News – For veterans receiving warfarin for nonvalvular atrial fibrillation, continuing warfarin after a diagnosis of dementia is associated with a protective effect in prevention of stroke and mortality, according to a study published online in the Journal of the American Geriatrics Society.
Ariela R. Orkaby, MD, from the Veterans Affairs Boston Healthcare System, and colleagues conducted a retrospective cohort study involving 2572 veterans aged 65 years and older who had been receiving warfarin for nonvalvular atrial fibrillation for 6 months or more and were newly diagnosed with dementia. Participants were followed for up to 4 years.
The researchers found that 405 individuals (16%) persisted on warfarin therapy after a diagnosis of dementia. Warfarin had a significant protective effect in prevention of ischemic stroke, major bleeding, and all-cause mortality (hazard ratios [HRs]: 0.64 [95% CI, 0.46-0.89; P =.008], 0.72 [95% CI, 0.55-0.94; P =.02], and 0.66 [95% CI, 0.55-0.79; P <.001], respectively).
The protective effect of continuing warfarin persisted in prevention of stroke and mortality in propensity-matched analyses (HRs: 0.74 [95% CI, 0.54-0.996; P =.047] and 0.72 [95% CI, 0.60-0.87; P <.001], respectively); there was no statistically significant decrease in the risk of major bleeding (HR: 0.78 [95% CI, 0.61-1.01; P =.06]).
"Discontinuing warfarin after a diagnosis of dementia is associated with a significant increase in stroke and mortality," the authors wrote.
Orkaby AR, Ozonoff A, Reisman JI, Miller DR, Zhao S, Rose AJ. Continued use of warfarin in veterans with atrial fibrillation after dementia diagnosis [Published online December 30, 2016]. J Am Geriatr Soc. doi:1111.jgs.14573.