Factors influencing cognitive performance after 1-year treatment with direct oral anticoagulant in patients with atrial fibrillation and previous ischemic stroke: a pilot study.
J Thromb Thrombolysis
; 51(3): 767-778, 2021 Apr.
Article
en En
| MEDLINE
| ID: mdl-32728909
ABSTRACT
Anticoagulant treatment as stroke prevention, particularly direct oral anticoagulant (DOAC), may reduce the risk of dementia in patients with atrial fibrillation (AF). We aimed to assess factors influencing cognitive performance after 1-year treatment with DOAC in patients with AF and previous ischemic stroke. We recruited 33 ischemic stroke patients who were discharged from Verona Stroke Unit with diagnosis of AF and prescription of treatment with DOAC. For each cognitive test, we estimated the effect of T0 (first session) variables on T1 (1-year session) cognitive performance using ordinal logistic regression fitted to a 1 point-shift from 4 to 0 on ESs. The effect of T0 clinical variables was presented as odds ratio (OR) with 95% confidence interval (CI) after adjustment for T0 total score of the corresponding cognitive test. Sustained AF (OR 4.259, 95% CI 1.071-16.942) and ischemic heart disease (OR 6.654, 95% CI 1.329-33.300) showed a significant effect on T1 MoCA Test; congestive heart failure on T1 RAVLT Immediate recall (OR 9.128, 95% CI 1.055-78.995), T1 RAVLT Delayed recall (OR 7.134, 95% CI 1.214-52.760), and T1 Trail Making Test (Part A) (OR 16.989, 95% CI 1.765-163.565); sustained AF (OR 5.055, 95% CI 1.224-20.878) and hyperlipidemia (OR 4.764, 95% CI 1.175-19.310) on T1 Digit span forward Test; ischemic heart disease (aOR 8.460, 95% CI 1.364-52.471) on T1 Stroop Color and Word Test (time); Dabigatran use (aOR 0.084, 95% CI 0.013-0.544) on FAB; age ≥ 75 years (aOR 0.058, 95% CI 0.006-0.563) and hyperlipidemia (aOR 5.809, 95% CI 1.059-31.870) on T1 Phonemic word fluency Test; female sex (aOR 6.105, 95% CI 1.146-32.519), hyperlipidemia (aOR 21.099, 95% CI 2.773-160.564), total Modified Fazekas Scale score > 1 (aOR 78.530, 95% CI 3.131-1969.512) on Semantic word fluency Test. Sustained AF, ischemic heart disease, congestive heart failure, hyperlipidemia, and female sex were the factors influencing cognitive performance after 1-year treatment with DOAC in patients with AF and previous ischemic stroke. Modified Fazekas Scale score in the first session was the only radiological variable that had a significant effect on cognitive performance.
Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Fibrilación Atrial
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Cognición
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Demencia
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Dabigatrán
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Accidente Cerebrovascular Isquémico
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
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Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
País como asunto:
Europa
Idioma:
En
Año:
2021
Tipo del documento:
Article