People with dementia less likely to receive oral anticoagulants despite stroke risk

Despite facing a similar or greater risk of stroke, people with dementia are less likely to receive oral anticoagulants.

woman with dementia ss 18

People with atrial fibrillation (AF) who have dementia are less likely to receive oral anticoagulants (OACs) than those without cognitive impairment, research has shown[1]
.

The systematic review analysed 21 studies on the prevalence of OAC use in AF, involving 14,734 people with dementia or cognitive impairment and 307,961 people without.

The results showed that 32% of people with dementia received OACs, compared with 48% of those without dementia, equating to a 52% reduced odds of receiving an OAC. The researchers also said the review highlighted a lack of data on the safety and efficacy of OACs in people with dementia.

Reporting in the Journal of Alzheimer’s Disease (21 August 2018), the team said there were several possible reasons people with dementia are less likely to receive an OAC, including fear of bleeding complications, poor adherence, difficulties with self-monitoring and polypharmacy. However, previous research has suggested that dementia may be associated with an increased risk of stroke in AF.

“Studies of the safety of OAC specifically in people with AF and dementia of various types, investigating the OAC type, dose, and adherence, are urgently needed to guide treatment,” the researchers concluded.

References

[1] Fanning L, Ryan-Atwood T, Bell S et al. Prevalence, safety, and effectiveness of oral anticoagulant use in people with and without dementia or cognitive impairment: a systematic review and meta-analysis. J Alzheimers Dis 2018;65:489–517. doi: 10.3233/JAD-180219

Last updated
Citation
Clinical Pharmacist, CP, October 2018, Vol 10, No 10;10(10):DOI:10.1211/PJ.2018.20205507