A new study presented at the American Heart Association meeting in Chicago indicates that blood thinners may not prevent cognitive decline in patients with atrial fibrillation (A-fib). The research, which investigated the effects of anti-clotting medication on mental decline, stroke, and mini-stroke risks, suggests that these medications do not provide cognitive benefits for younger adults with A-fib.
Study Details and Findings
The study, led by Dr. Lena Rivard from the University of Montreal, involved over 1,200 adults with A-fib but without standard risk factors that typically necessitate blood thinners. Participants, with an average age of 53, were administered either 15 mg of rivaroxaban daily or a placebo. The trial was halted after approximately 3.5 years due to the evident lack of cognitive benefit from the medication, despite initial plans to continue for five years.
Cognitive functions were assessed annually using the Montreal Cognitive Assessment. A decline of 2 points or more was considered significant. After nearly four years, 20% of participants experienced mental decline, stroke, or transient ischemic attacks (TIAs). Cognitive decline accounted for 91% of these outcomes. Notably, there were no significant differences in outcomes between the rivaroxaban and placebo groups.
Implications for Clinical Practice
The research underscores that younger individuals with A-fib, who lack additional stroke risk factors, have a low stroke rate. According to Dr. Rivard, these findings support current guidelines advising against the over-treatment of such patients with anticoagulant therapy. The study also revealed that major bleeding occurred in 1 in 200 participants, and stroke occurred in fewer than 1 in 100 participants (0.8%) annually.
Expert Recommendations
Dr. Rivard emphasized that patients should adhere to standard recommendations for cognitive health, including adopting a healthy lifestyle, engaging in brain-stimulating activities, and maintaining regular physical activity. The study confirms that anticoagulation is not useful in reducing the risk of cognitive decline in this patient population.
A-fib and Cognitive Decline
A-fib, characterized by an irregular heartbeat, can lead to severe complications such as heart failure and stroke. While observational studies have suggested a link between A-fib and cognitive decline, this trial provides evidence that anticoagulation therapy does not mitigate this risk in younger adults with A-fib who do not have other stroke risk factors.
