长期的认知功能变化与非维生素K口服抗凝剂在老年患者心房动. 一个多中心队列研究
Giuseppe Armentaro1, Graziella D'Arrigo2, Daniele Pastori3
1Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy.
European journal of clinical investigation
|September 23, 2024
概括
较新的抗凝剂,非维生素K口服抗凝剂 (NOACs),在心房患者中,与较旧的维生素K抗剂 (VKAs) 相比,在长时间内保持认知功能方面具有更大的益处.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 药理学 药理学是指药理学的学科.
背景情况:
- 心房动 (AF) 与认知能力下降有关,特别是在老年人中.
- 目前的抗凝剂,包括非维生素K口服抗凝剂 (NOAC) 和维生素K抗剂 (VKA),旨在预防AF患者的血栓栓塞事件.
- 这些抗凝剂对认知功能下降的影响仍在争论中.
研究的目的:
- 为了比较NOACs与VKAs对非膜AF的老年患者认知功能下降的影响.
- 为了评估NOACs和VKAs患者之间的认知功能随时间变化的绝对和相对变化.
主要方法:
- 一项多中心观察研究包括983名患有非膜AF的老年患者 (平均年龄为76岁).
- 患者接受了NOAC (692) 或VKA (291) 的治疗.
- 认知功能使用微型心理状态检查 (MMSE) 评分进行评估,使用线性混合模型和基于组的轨迹模型进行分析.
主要成果:
- 在平均7.2年的随访期间,接受NOAC治疗的患者在MMSE得分的绝对降低明显较小 (-0.3),相比于接受VKA治疗的患者 (-1.7) (p < 0.001).
- 基于小组的轨迹分析显示,接受NOAC的患者属于认知衰退速度较慢的轨迹的概率是3.93至13.88倍.
- 即使考虑到NOACs组中年龄较大和更高的并发症负担,这些发现仍然是正确的.
结论:
- 在老年患有AF的患者中,NOAC与VKA相比,与认知功能下降的速度较慢有关.
- 尽管NOACs组年龄较大,并患有更多的并发症,但在认知保存方面观察到这种益处.
- 该研究表明,NOACs可能在维持AF患者的认知健康方面具有优势.
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