Evidence map›Paper›PMID 36581462›Full record

ArticleNeurology2023

Oral Anticoagulants and the Risk of Dementia in Patients With Nonvalvular Atrial Fibrillation: A Population-Based Cohort Study.

Alvi A Rahman, Jonathan Michaud, Sophie Dell'Aniello, Erica E M Moodie, James M Brophy, Madeleine Durand, Jason R Guertin, Jean-François Boivin, Christel Renoux

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed
3.1field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 21 citations in OpenAlex.

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  5. Vascular cognitive impairment and dementia: Mechanisms, treatment, and future directions.International journal of stroke : official journal of the International Stroke Society · 2024
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 1 institution in 1 country.

Alvi A RahmanFrom the Departments of Epidemiology, Biostatistics and Occupational Health (A.R., E.E.M.M., J.M.B., J.-F.B., C.R.), Medicine (J.M.B.), and Neurology and Neurosurgery (C.R.), McGill University, Montreal; Centre for Clinical Epidemiology (A.R., J.M., S.D., J.-F.B., C.R.), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Department of Medicine (M.D.), Université de Montréal; Centre de recherche du Centre Hospitalier de l'Université de Montréal (M.D.); and Département de Médecine Sociale et Préventive (J.R.G.), Faculté de médecine, Université Laval, Montreal, Canada.ORCID 0000-0001-8881-7020
Jonathan MichaudFrom the Departments of Epidemiology, Biostatistics and Occupational Health (A.R., E.E.M.M., J.M.B., J.-F.B., C.R.), Medicine (J.M.B.), and Neurology and Neurosurgery (C.R.), McGill University, Montreal; Centre for Clinical Epidemiology (A.R., J.M., S.D., J.-F.B., C.R.), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Department of Medicine (M.D.), Université de Montréal; Centre de recherche du Centre Hospitalier de l'Université de Montréal (M.D.); and Département de Médecine Sociale et Préventive (J.R.G.), Faculté de médecine, Université Laval, Montreal, Canada.ORCID 0000-0002-4188-7109
Sophie Dell'AnielloFrom the Departments of Epidemiology, Biostatistics and Occupational Health (A.R., E.E.M.M., J.M.B., J.-F.B., C.R.), Medicine (J.M.B.), and Neurology and Neurosurgery (C.R.), McGill University, Montreal; Centre for Clinical Epidemiology (A.R., J.M., S.D., J.-F.B., C.R.), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Department of Medicine (M.D.), Université de Montréal; Centre de recherche du Centre Hospitalier de l'Université de Montréal (M.D.); and Département de Médecine Sociale et Préventive (J.R.G.), Faculté de médecine, Université Laval, Montreal, Canada.
Erica E M MoodieFrom the Departments of Epidemiology, Biostatistics and Occupational Health (A.R., E.E.M.M., J.M.B., J.-F.B., C.R.), Medicine (J.M.B.), and Neurology and Neurosurgery (C.R.), McGill University, Montreal; Centre for Clinical Epidemiology (A.R., J.M., S.D., J.-F.B., C.R.), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Department of Medicine (M.D.), Université de Montréal; Centre de recherche du Centre Hospitalier de l'Université de Montréal (M.D.); and Département de Médecine Sociale et Préventive (J.R.G.), Faculté de médecine, Université Laval, Montreal, Canada.
James M BrophyFrom the Departments of Epidemiology, Biostatistics and Occupational Health (A.R., E.E.M.M., J.M.B., J.-F.B., C.R.), Medicine (J.M.B.), and Neurology and Neurosurgery (C.R.), McGill University, Montreal; Centre for Clinical Epidemiology (A.R., J.M., S.D., J.-F.B., C.R.), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Department of Medicine (M.D.), Université de Montréal; Centre de recherche du Centre Hospitalier de l'Université de Montréal (M.D.); and Département de Médecine Sociale et Préventive (J.R.G.), Faculté de médecine, Université Laval, Montreal, Canada.
Madeleine DurandFrom the Departments of Epidemiology, Biostatistics and Occupational Health (A.R., E.E.M.M., J.M.B., J.-F.B., C.R.), Medicine (J.M.B.), and Neurology and Neurosurgery (C.R.), McGill University, Montreal; Centre for Clinical Epidemiology (A.R., J.M., S.D., J.-F.B., C.R.), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Department of Medicine (M.D.), Université de Montréal; Centre de recherche du Centre Hospitalier de l'Université de Montréal (M.D.); and Département de Médecine Sociale et Préventive (J.R.G.), Faculté de médecine, Université Laval, Montreal, Canada.
Jason R GuertinFrom the Departments of Epidemiology, Biostatistics and Occupational Health (A.R., E.E.M.M., J.M.B., J.-F.B., C.R.), Medicine (J.M.B.), and Neurology and Neurosurgery (C.R.), McGill University, Montreal; Centre for Clinical Epidemiology (A.R., J.M., S.D., J.-F.B., C.R.), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Department of Medicine (M.D.), Université de Montréal; Centre de recherche du Centre Hospitalier de l'Université de Montréal (M.D.); and Département de Médecine Sociale et Préventive (J.R.G.), Faculté de médecine, Université Laval, Montreal, Canada.ORCID 0000-0003-1718-5307
Jean-François BoivinFrom the Departments of Epidemiology, Biostatistics and Occupational Health (A.R., E.E.M.M., J.M.B., J.-F.B., C.R.), Medicine (J.M.B.), and Neurology and Neurosurgery (C.R.), McGill University, Montreal; Centre for Clinical Epidemiology (A.R., J.M., S.D., J.-F.B., C.R.), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Department of Medicine (M.D.), Université de Montréal; Centre de recherche du Centre Hospitalier de l'Université de Montréal (M.D.); and Département de Médecine Sociale et Préventive (J.R.G.), Faculté de médecine, Université Laval, Montreal, Canada.
Christel RenouxFrom the Departments of Epidemiology, Biostatistics and Occupational Health (A.R., E.E.M.M., J.M.B., J.-F.B., C.R.), Medicine (J.M.B.), and Neurology and Neurosurgery (C.R.), McGill University, Montreal; Centre for Clinical Epidemiology (A.R., J.M., S.D., J.-F.B., C.R.), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada; Department of Medicine (M.D.), Université de Montréal; Centre de recherche du Centre Hospitalier de l'Université de Montréal (M.D.); and Département de Médecine Sociale et Préventive (J.R.G.), Faculté de médecine, Université Laval, Montreal, Canada. christel.renoux@mcgill.ca.ORCID 0000-0002-4691-9579
Jewish General Hospital · CA

Funding

CIHR
6 · The paper itself

Abstract

BACKGROUND AND

objectivesNonvalvular atrial fibrillation (NVAF) is associated with an increased risk of dementia. Oral anticoagulants (OACs) are essential for stroke prevention in NVAF, and studies have shown a possible protective effect on dementia. However, findings have been inconsistent and hampered by methodological limitations. Thus, we assessed whether the use of OACs is associated with a decreased incidence of dementia in patients with NVAF. In addition, we explored the impact of the cumulative duration of OAC use on the incidence of dementia.

methodsUsing the UK Clinical Practice Research Datalink, we formed a cohort of all patients aged 50 years or older with an incident diagnosis of NVAF between 1988 and 2017 and no prior OAC use, with a follow-up until 2019. Patients were considered unexposed until 6 months after their first OAC prescription for latency considerations and exposed thereafter until the end of follow-up. We used time-dependent Cox regression models to estimate hazard ratios (HRs), adjusted for 54 covariates, with 95% CIs for dementia associated with OAC use, compared with nonuse. We also assessed whether the risk varied with the cumulative duration of OAC use, compared with nonuse, by comparing prespecified exposure categories defined in a time-varying manner and by modeling the HR using a restricted cubic spline.

resultsThe cohort included 142,227 patients with NVAF, with 8,023 cases of dementia over 662,667 person-years of follow-up (incidence rate 12.1, 95% CI 11.9-12.4 per 1,000 person-years). OAC use was associated with a decreased risk of dementia (HR 0.88, 95% CI 0.84-0.92) compared with nonuse. A restricted cubic spline also indicated a decreased risk of dementia, reaching a low at approximately 1.5 years of cumulative OAC use and stabilizing thereafter. Moreover, OAC use decreased the risk in patients aged 75 years and older (HR 0.84, 95% CI 0.80-0.89), but not in younger patients (HR 0.99, 95% CI 0.90-1.10). DISCUSSION: In patients with incident NVAF, OACs were associated with a decreased risk of dementia, particularly in elderly individuals. This warrants consideration when weighing the risks and benefits of anticoagulation in this population. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in patients with NVAF, OAC use (vs nonuse) is associated with a decreased risk of dementia.

Indexed as

Atrial FibrillationDementiaStrokeAdministration, OralAgedAnticoagulantsCohort StudiesHumansRetrospective StudiesAnticoagulants

Identifiers

PMID36581462
PMCPMC10033170
OpenAlexW4313312389

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.