Dementia in subjects with atrial fibrillation: hemostatic function and the role of anticoagulation

Barber, M., Tait, R.C. , Scott, J., Rumley, A., Lowe, G. and Stott, D.J. (2004) Dementia in subjects with atrial fibrillation: hemostatic function and the role of anticoagulation. Journal of Thrombosis and Haemostasis, 2(11), pp. 1873-1878. (doi: 10.1111/j.1538-7836.2004.00993.x) (PMID:15550013)

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Abstract

Summary. Background: Atrial fibrillation (AF) is associated with cognitive impairment and dementia, perhaps through encouraging a prothrombotic state and cardioembolism. Objectives: We wished to test the hypotheses that hemostatic function is altered in subjects with AF who develop dementia, and that long‐term warfarin anticoagulation is protective against this complication. Patients and methods: Recruitment was from an observational cohort study of AF. Baseline assessment included measurement of plasma fibrinogen, fibrin D‐dimer, prothrombin fragment 1+2 (F1+2), thrombin–antithrombin complexes (TAT), von Willebrand factor and tissue plasminogen activator. We assessed cognitive function after 3 years' follow‐up using the 13‐item modified Telephone Interview for Cognitive Status (TICSm) and the short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Results: Of the 218 subjects assessed, 145 (66%) were prescribed warfarin. Forty‐nine (22%) met TICSm/IQCODE criteria for dementia. D‐dimer, F1+2 and TAT levels were higher in AF subjects with dementia compared with those without (medians 81 vs. 60 ng mL−1, P = 0.008; 0.76 vs. 0.49 nmol L−1, P = 0.006; and 1.78 vs. 1.44 µg L−1, P = 0.003, respectively). These associations became of borderline statistical significance following adjustment for age. Logistic regression showed a trend towards warfarin use being independently associated with reduced prevalence of dementia (odds ratio 0.52, P = 0.08). Conclusions: We found evidence of increased thrombin generation and fibrin turnover in subjects with AF and dementia compared with those without dementia. Long‐term warfarin use may be protective against the development of dementia in subjects with AF.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Stott J, Professor David and Rumley, Dr Ann and Lowe, Professor Gordon and Tait, Dr Robert
Authors: Barber, M., Tait, R.C., Scott, J., Rumley, A., Lowe, G., and Stott, D.J.
College/School:College of Medical Veterinary and Life Sciences
College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Journal of Thrombosis and Haemostasis
Publisher:International Society on Thrombosis and Haemostasis
ISSN:1538-7933
ISSN (Online):1538-7836
Published Online:10 November 2004

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