Benefits of Warfarin After Dementia Diagnosis Explored

Findings in cohort of veterans aged 65 years or older receiving warfarin for nonvalvular atrial fibrillation
Findings in cohort of veterans aged 65 years or older receiving warfarin for nonvalvular atrial fibrillation

HealthDay News — For veterans receiving warfarin for nonvalvular atrial fibrillation, continuing warfarin after a diagnosis of dementia is associated with a protective effect in prevention of stroke and mortality, according to a study published online December 30 in the Journal of the American Geriatrics Society.

Ariela R. Orkaby, MD, from the Veterans Affairs Boston Healthcare System, and colleagues conducted a retrospective cohort study involving 2,572 veterans aged 65 years and older who had been receiving warfarin for nonvalvular atrial fibrillation for six months or more and were newly diagnosed with dementia. Participants were followed for up to four years. 

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The researchers found that 405 individuals (16%) persisted on warfarin therapy after a diagnosis of dementia. Warfarin had a significant protective effect in prevention of ischemic stroke, major bleeding, and all-cause mortality (hazard ratios [HRs], 0.64 [95% confidence interval (CI), 0.46 to 0.89; P=0.008], 0.72 [95% CI, 0.55 to 0.94; P=0.02], and 0.66 [95% CI, 0.55 to 0.79; P<0.001], respectively). The protective effect of continuing warfarin persisted in prevention of stroke and mortality in propensity-matched analyses (HRs, 0.74 [95% CI, 0.54 to 0.996; P=0.047] and 0.72 [95% CI, 0.60 to 0.87; P<0.001], respectively); there was no statistically significant decrease in the risk of major bleeding (HR, 0.78 [95% CI, 0.61 to 1.01; P=0.06]).

"Discontinuing warfarin after a diagnosis of dementia is associated with a significant increase in stroke and mortality," the authors write.

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