New brain infarcts present at 2 years in more than 5% of patients with AF despite anticoagulation
In well-treated patients with atrial fibrillation, most of whom were on oral anticoagulation, more than 5% had a new brain infarct at 2 years, according to data presented at the virtual Heart Rhythm Society Annual Scientific Sessions.
“We think that although many patients do benefit from oral anticoagulation, this treatment alone may not be sufficient to prevent brain damage in all patients with atrial fibrillation,” David Conen, MD, MPH, associate professor of medicine (cardiology) at McMaster University in Hamilton, Ontario, Canada, said during a press conference.
Conen and colleagues prospectively analyzed 1,227 patients with AF (mean age, 71 years; 26% women) from the SWISS-AF cohort who had a brain MRI at baseline and at 2 years.
Among the cohort, 90% of patients were taking oral anticoagulation at baseline and 84% were taking it at 2 years.
Conen said during a press conference that 5.5% of patients had a new brain infarct at 2 years.
He said among the 68 patients with a new brain infarct, 85.3% had a silent event, 86.8% were taking oral anticoagulation and 75% had a silent event while taking oral anticoagulation.
Patients with new brain infarcts had a greater degree of cognitive decline compared with patients who did not have them (P < .05), he said.
“The absolute differences were small, but were statistically significant in three out of five test scores, meaning that those with a brain infarct during follow-up had a steeper decline in cognitive function than those without a brain infarct on MRI,” he said during the press conference.
Conen said his advice for clinicians is: “Anticoagulate patients with atrial fibrillation when there is an indication for it, but also look to optimize the vascular risk factors in these patients with multiple comorbidities, including high blood pressure and diabetes. Make sure that they get a statin if needed and make them stop smoking if possible.” – by Erik Swain
Conen D, et al. LBCT03-02. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 6-9, 2020 (virtual meeting).
Disclosure: Conen reports he spoke for Servier Canada.