Avaliação do impacto dos anticoagulantes na incidência de demência em pacientes com fibrilação atrial: uma revisão narrativa
DOI:
https://doi.org/10.11606/issn.1679-9836.v102i4e-203462Palavras-chave:
Fibrilação atrial; demência; anticoagulanteResumo
A fibrilação atrial (FA) é o tipo mais comum de arritmia cardíaca e está associada a um maior risco de demência. Acredita-se que o uso de fármacos anticoagulantes orais seja um fator protetivo para o desenvolvimento de demência. Assim, essa revisão narrativa teve o objetivo de apresentar e discutir a evidência atual sobre o impacto do uso de anticoagulantes e o comprometimento cognitivo em pessoas com fibrilação atrial. A seleção foi feita usando os MeSH terms: atrial fibrillation; dementia; treatment; anticoagulants. Foram incluídos ensaios clínicos randomizados ou coortes prospectivos publicados entre 2015 e 2021, desenvolvidos em seres humanos. Foram identificados 155 artigos, sendo que 10 cumpriam os critérios de inclusão. A maioria dos estudos analisados observaram uma diminuição no risco de demência com o uso dos NOACs (novos anticoagulantes orais) em relação ao uso da varfarina. O estudo de Kim et al (2021) aponta a rivaroxabana como droga mais eficiente para diminuição do risco de demência, dentre os NOACs. Contudo, Søgaard et al (2019) apresentaram um risco maior de demência associado ao uso dos NOACs, quando comparado a varfarina. Conclui-se, que os NOACs e a varfarina, diminuem o risco de quadro demencial em pessoas com FA. No entanto, ainda não é possível afirmar o melhor tratamento oferecido atualmente.
Downloads
Referências
Mann D, Zipes DP, Libby P, Bonow RO. Braunwald: Tratado de doenças cardiovasculares. 10ª ed. Rio de Janeiro: Elsevier Editora Ltda; 2018. v.2.
Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge. Int J Stroke. 2021;16(2):217-21. doi:10.1177/1747493019897870.
Vlachos K, Letsas KP, Korantzopoulos P, Liu T, Georgopoulos S, Bakalakos A, et. al. Prediction of atrial fibrillation development and progression: Current perspectives. World J Cardiol. 2016;8(3):267-76. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4807315/.
Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498. doi:10.1093/eurheartj/ehaa612.
Carlsson J, Miketic S, Windeler J, Cuneo A, Haun S, Micus S, Walter S, Tebbe U; STAF Investigators. Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: the Strategies of Treatment of Atrial Fibrillation (STAF) study. J Am Coll Cardiol. 2003 May 21;41(10):1690-6. doi: 10.1016/s0735-1097(03)00332-2. https://www.sciencedirect.com/science/article/pii/S0735109703003322?via%3Dihub.
Sanders A, Absher J, Shugarman S, Nininger J, Bennett A, Roca R. Quality improvement in neurology: dementia management quality measurement set update. Neurology. 2017;88(20):1951-7. https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2017.17401?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed.
Dening T, Sandilyan MB. Dementia: definitions and types. Nurs Stand. 2015;29(37):37-42. https://pubmed.ncbi.nlm.nih.gov/25967445/.
O’Brien JT, Thomas A. Vascular dementia. Lancet. 2015;386(10004):1698-706. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00463-8/fulltext.
Wolters FJ, Ikram MA. Epidemiology of vascular dementia. Arterioscler Thromb Vasc Biol. 2019;39(8):1542-9. https://www.ahajournals.org/doi/full/10.1161/ATVBAHA.119.311908?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org.
Ott A, Breteler MM, Bruyne MC, Harskamp F, Grobbee DE, Horman A. Atrial fibrillation and dementia in a population-based study: the rotterdam study. Stroke. 1997;28(2):316-21. https://www.ahajournals.org/doi/10.1161/01.str.28.2.316?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed.
Aldrugh S, Sardana M, Henninger N, Saczynski JS, McManus DD. Atrial fibrillation, cognition and dementia: a review. J Cardiovasc Electrophysiol. 2017;28(8):958–65. https://www.ncbi.nlm.nih
Danese E, Montagnana M, Cervellin G, Lippi G. Hypercoagulability, D-dimer and atrial fibrillation: an overview of biological and clinical evidence. Ann Med. 2014;46(6):364‐71. https://www.tandfonline.com/doi/full/10.3109/07853890.2014.912835.
Watson T, Shantsila E, Lip GY. Mechanisms of thrombogenesis in atrial fibrillation: Virchow's triad revisited. Lancet. 2009;373(9658):155‐66. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60040-4/fulltext.
Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010 Feb;137(2):263-72. https://pubmed.ncbi.nlm.nih.gov/19762550/.
Søgaard M, Skjøth F, Jensen M, Kjældgaard, JN, Lip, G., Larsen, TB, Nielsen, PB. Nonvitamin K antagonist oral anticoagulants versus warfarin in atrial fibrillation patients and risk of dementia. A nationwide propensity-weighted cohort study. J Amn Heart Assoc. 2019;8(11):e011358. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585353/.
Mongkhon P, Fanning L, Lau WCY, Tse G, Lau KK, Wei L, Kongkaew C, Wong ICK. Oral anticoagulant and reduced risk of dementia in patients with atrial fibrillation: a population-based cohort study. Heart Rhythm. 2020;17(5 Pt A):706-13. https://www.heartrhythmjournal.com/article/S1547-5271(20)30011-4/fulltext.
Friberg L, Rosenqvist M. Less dementia with oral anticoagulation in atrial fibrillation. Eur Heart J. 2018;39(6):453-60. https://pubmed.ncbi. nlm.nih.gov/29077849/.
Ding M, Fratiglioni L, Johnell K, et al. Atrial fibrillation, antithrombotic treatment, and cognitive aging: A population-based study. Neurology. 2018;91(19):e1732-e1740. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6251601/.
Field TS, Weijs B, Curcio A, Giustozzi M, Sudikas S, Katholing A, Wallenhorst C, Weitz JI, Cohen AT, Martinez C. Incident atrial fibrillation, dementia and the role of anticoagulation: a population-cased cohort study. Thromb Haemost. 2019;119(6):981–91. https://pubmed.ncbi.nlm.nih.gov/30919384/.
Friberg L, Andersson T, Rosenqvist M. Less dementia and stroke in low-risk patients with atrial fibrillation taking oral anticoagulation. Eur Heart J. 2019;40(28):2327-35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642728/
Kim D, Yang PS, Jang E, et al. Association of anticoagulant therapy with risk of dementia among patients with atrial fibrillation. Europace. 2021;23(2):184-95. https://pubmed.ncbi.nlm.nih.gov/33063123/.
Wändell P, Carlsson AC, Sundquist J, et al. Antihypertensive drugs and relevant cardiovascular pharmacotherapies and the risk of incident dementia in patients with atrial fibrillation. Int J Cardiol. 2018;1(272):149-54. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6690390/.
Mailhot T, McManus DD, Waring ME, et al. Frailty, cognitive impairment, and anticoagulation among older adults with nonvalvular atrial fibrillation. J Am Geriatr Soc. 2020;68(12):2778-86. https://www.ncbi.nlm.nih. gov/pmc/articles/PMC8567309/.
Hyogo K, Yoshida A, Takeuchi M, et al; One-year clinical outcomes of anticoagulation therapy among Japanese patients with atrial fibrillation: the Hyogo AF Network (HAF-NET) Registry. J Arrhythm. 2019;35(5):697-708. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6786980/.
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2023 Caroline Fonseca Teixeira, Rodrigo Taranto de Reis, Larissa Rodrigues Perrenout Branca, Igor Dutra Braz
Este trabalho está licenciado sob uma licença Creative Commons Attribution-ShareAlike 4.0 International License.
