23 Nov AHA21: GIRAF Study Results Comparing Anticoagulants and Cognitive Decline in AFib Patients
MedicalResearch.com Interview with:
Bruno Caramelli MD PhD
Associate Professor of Medicine
University of Sao Paulo, Brasil
Director, Interdisciplinary Medicine in Cardiology Unit
Chairman of the PhD program in Medical Sciences at the University of Sao Paulo, Brazil.
President of the Department of Clinical Cardiology at the Brazilian Society of Cardiology
FESC: Fellow of the European Society of Cardiology
MedicalResearch.com: What is the background for this study?
Response: Atrial fibrillation is the most common cardiac arrhythmia in older adults, and it is associated with an increased risk of stroke, cognitive impairment, and dementia. Stroke can occur when a blood clot blocks blood flow to the brain, and oral anticoagulants, such as dabigatran and warfarin, are typically prescribed to prevent stroke. Dabigatran has been found to be comparable to warfarin for the prevention of stroke and also has a lower risk of major bleeding complications.
Previous research has shown that people with atrial fibrillation taking oral anticoagulation therapy have a lower risk of dementia, however, the mechanism involved in this benefit is unknown, and previous clinical trials have not evaluated cognitive and functional impairment outcomes among patients.
It’s possible that cognitive decline is related to the formation of small blood clots in the brain, which is treated by effective medications that prevent blood clots. Since dabigatran offers a more stable anticoagulation status, we investigated whether it would be more effective than warfarin for the prevention of cognitive decline in patients with atrial fibrillation.
Previous studies were retrospective and observational studies and considered tests that evaluate global cognitive function in a generic, global, and non-specific way. In that way its not possible to exclude different causes of dementia as Alzheimer’s disease and others making it difficult to establish an effect directly related to atrial fibrillation or the anticoagulation treatment.
MedicalResearch.com: What are the main findings?
Response: Making and more comprehensive an extensive cognitive evaluation, we found no significant changes between groups from baseline estimates (points) and 95% confidence intervals (segments) in the outcome for each individual cognitive test and for tests grouped by cognitive domains. It’s important to say, differently from previous observational studies, that cognitive decline was not significant in the period of two years of the GIRAF study. Moreover, it’s important to say that TTR was 69% for Warfarin treated patients, considered very good.
MedicalResearch.com: What should readers take away from your report?
Response: The main take-home message is that older patients with atrial fibrillation do not show significant cognitive decline if they are adequately treated with anticoagulation drugs. We observed no significant differences when comparing Warfarin to Dabigatran.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: GIRAF study established a new reference for cognitive evaluation to be considered in clinical trials in cardiology. Additionally, GIRAF study suggests that for the preservation of cognitive function in patients with atrial fibrillation, adequate treatment is more important than the choice of the drug for anticoagulation.
Caramelli B. Dabigatran versus warfarin on cognitive outcomes in nonvalvular atrial fibrillation: results of the GIRAF trial. Presented at: AHA 2021. November 14, 2021.
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