Atrial fibrillation: Doubts about the use of anticoagulants for young patients

Taking anticoagulants does nothing to reduce the risk of cognitive decline or stroke in young, healthy patients being treated for atrial fibrillation, a Montreal Heart Institute (MHI) researcher has found.At present, doctors routinely prescribe anticoagulants to patients under 65 with no other cardiovascular risk factors, in the hope of preventing future sequelae.This practice could now change, predicted study author Dr. Léna Rivard.“We have an answer, which is that there's no point in giving this drug to reduce cognitive decline,” said Dr. Rivard, a cardiologist specializing in electrophysiology at the MHI and associate clinical professor in the faculty of medicine at the Université de Montréal. “The next step is to generate hypotheses to help these patients.”The BRAIN-AF study was stopped prematurely, as the data generated by Dr. 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% of study participants lost at least two points on the MoCA cognition rating scale during the average followup of 3.7 years, which corresponds to the decline normally seen in a patient during a 10-year followup, said Dr. Rivard. “You don't drop your MoCA by two points in four years,” she stressed.In light of these results, she added, doctors will now have 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 present, to determine which patients are at risk.“It shows us that the link (between AF and cognitive decline) isn't via cerebral emboli, that there's something else going on,” said Dr. Rivard. The next step is to look for ways to identify the population at risk of cognitive decline.To this end, Dr. Rivard is glad to be able to count on what she calls a “pure population,” i.e., young subjects with no risk factors, unlike previous studies in which several participants had heart disease.For now, she concluded, we can simply advise these otherwise healthy young patients to follow the usual healthy lifestyle advice.

Atrial fibrillation: Doubts about the use of anticoagulants for young patients

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