Major bleeding episodes and death occur more frequently in patients with cognitive impairment who receive anticoagulation for atrial fibrillation (AF), a study shows. Those with frailty had more bleeding episodes, but the interaction of anticoagulation and clinical outcomes was not significant.
The study included 1,244 individuals at clinics in Massachusetts and Georgia who had AF, age 65 years or older, and CHA2DS2VASc scores of 2 or more. Hazard ratios based on physician-adjudicated outcomes showed these results based on frailty status and cognitive function: “The average age was 75.5 (± 7.1) years, 49% were women, and 86% were prescribed oral anticoagulants. At baseline, 528 (42.4%) participants were cognitively impaired and 172 (13.8%) were frail. The adjusted hazard ratios of anticoagulation for the composite of major bleeding or death were 2.23 (95% confidence interval: 1.08–4.61) among cognitively impaired individuals and 0.94 (95% confidence interval: 0.49–1.79) among cognitively intact individuals (P for interaction = 0.08). Adjusted hazard ratios for anticoagulation were 1.84 (95% confidence interval: 0.66–5.13) among frail individuals and 1.39 (95% confidence interval: 0.84–2.40) among not frail individuals (P for interaction = 0.67).”