Atrial fibrillation: Montreal research assesses effectiveness of anticoagulants for certain patients

Taking anticoagulants does not reduce the risk of cognitive decline or stroke in young, healthy patients treated for atrial fibrillation, a researcher from the Montreal Heart Institute (ICM) has found.

Currently, doctors routinely prescribe anticoagulants to their patients under the age of 65 who do not have other cardiovascular risk factors in the hope of avoiding future after-effects.

This practice could now change, predicted the author of the study, Dr. Léna Rivard.

“We have an answer, that is to say that there is no point in giving this medication to reduce cognitive decline,” said Dr. Rivard, who is a cardiologist specializing in electrophysiology at the ICM and associate clinical professor at the faculty of medicine of the University of Montreal.

“The next step is to generate hypotheses to help these patients.”

The BRAIN-AF study was stopped prematurely, as the data generated by Rivard and her colleagues clearly demonstrated that taking anticoagulants had no impact on the risk of cognitive decline, stroke or transient ischemic attack in these otherwise healthy young patients.

Just under 20 per cent of study participants lost at least two points on the MoCA Cognition Rating Scale during the average follow-up of 3.7 years, consistent with the decline normally seen in a patient over a 10-year follow-up, Rivard said. “We do not lower our MoCA by two points in four years,” she insisted.

In light of these findings, she added, doctors will now need to try to understand how atrial fibrillation — the most common form of arrhythmia worldwide — increases the risk of dementia or cognitive decline later in life because they are unable, at this time, to determine which patients are at risk of being affected.

“It shows us that the link (between atrial fibrillation and cognitive decline) is not via cerebral embolisms, that there is something else,” said Rivard. “The next step is to be able to delimit the population which is at risk of lowering its cognitive test.”

To this end, Rivard is delighted to be able to count on what she calls a “pure population,” namely young subjects without risk factors, unlike previous studies in which we found several participants with heart disease.

For now, she concluded, these young, otherwise healthy patients can simply be advised to follow the usual advice regarding a healthy lifestyle.

The results of this study were revealed a few days ago in Chicago, as part of a congress of the American Heart Association.

–This report by La Presse Canadienne was translated by CityNews