A Systematic Review and Meta-analysis to Determine the Effect of Oral
Anticoagulants on Incidence of Dementia in Patients with Atrial
Fibrillation
Abstract
Aims: To assess the effect of oral anticoagulant (OAC) administration on
incidence of dementia in patients with atrial fibrillation (AF) with
Systematic review and meta-analysis in according with the Preferred
Reporting Items for Systematic Review and Meta-analysis Protocols.
Methods: We systematically searched the electronic databases including
Pubmed, Embase, Cochrane library, and ClinicalTrails.gov for relevant
articles. The primary outcome was the incidence of dementia. The
adjusted risk ratio (RR), odds ratio, or hazard ratio were extracted and
pooled by the random-effects models. Subgroup analysis was performed
according to the setting observational window. Risk of bias was assessed
using the Newcastle-Ottawa Scale, while publication bias was assessed by
the Begg’s and Egger’s tests. Results: Nine studies included in this
review (2 prospective and 7 retrospective observational studies,
including 613,920 patients). The results presented the significant
association between OAC therapy and the reduced risk of dementia
compared with no treatment (RR [95%CI] =0.72 [0.60, 0.86],
I2=97.2%; P =0.000). In the subgroup analysis, the pooled RR became
statistically non-significant (including four studies, RR [95%CI]
=0.75 [0.51, 1.10], I2=98.8%; P =0.000). There is no significant
risk of bias and publication bias. Conclusions: This study indicated the
protective effect of OAC therapy for dementia in patients with AF.
However, the results are limited because of high heterogeneity,
inconsistent direction of effect in subgroup analysis. Further
prospective well-designed study is needed with longer follow-up duration
in younger patients.