| Objective: Warfarin is widely used in the prevention of stroke caused by cerebral embolism in patients with nonvalvular atrial fibrillation.NOACs are associated with a lower risk of bleeding and fewer drug interactions than warfarin,and it is unknown whether they are superior to warfarin in delaying cognitive decline.Therefore,this study aims to explore the effects of warfarin and Rivaroxaban,one of the NOACs,on cognitive dysfunction in elderly patients with NVAF.Methods: 1.Using the prospective study method,127 NVAF patients who met the inclusion and exclusion criteria admitted to the Affiliated Hospital of Yangzhou University from December 1,2021 to April 30,2022 were collected and divided into 52 patients in the control group according to their anticoagulant drug use(no anticoagulant drug use,And/or platelet drugs),36 cases in the warfarin group and 39 cases in the rivaroxaban group.2.Clinical data of all patients were collected,cognitive function was assessed by the Montreal Cognitive Assessment Scale,and vitamin K levels were detected by enzyme-linked immunosorbent assay.3.Firstly,the general clinical data of the control group and the anticoagulant group(including warfarin and rivaroxaban),and the warfarin and rivaroxaban groups were compared.Then,the patients were divided into two groups for univariate and multivariate analysis according to whether they had cognitive dysfunction.Finally,the subitem score of the Mo CA scale and the level of vitamin K in the control group,warfarin and rivaroxaban groups were compared.4.In general clinical data,education level was statistically analyzed by Mann-Whitney U test,other quantitative data was statistically analyzed by independent sample t test,and categorical variables such as hypertension,diabetes,smoking history and drinking history were statistically analyzed by Pearson’s Chi-square test.Univariate analysis of variance and binary Logistic regression were used to identify the factors associated with cognitive dysfunction.Kruskal-Wallis test was used for statistical analysis of subitem scores in Mo CA scale and serum vitamin K level.All data were analyzed by SPSS 26.0 software program,and the difference could be considered statistically significant when P < 0.05.Results: 1.A total of 127 patients were included in this study,including 76males(59.8%)and 51 females(40.2%),with an average age of(75.26±7.82)years.52 patients(40.9%)received neither anticoagulation nor antiplate treatment,and were the blank control group.Thirty-six patients(28.4%)received anticoagulation therapy with warfarin and 39 patients(30.7%)received anticoagulation therapy with rivaroxaban.2.Mo CA scores increased significantly in the anticoagulant group compared to the control group(anticoagulant vs.No antithrombotic group;19.95±4.05 vs.18.19±5.02,P<0.05),atrial fibrillation time and hypertension were significantly different(P<0.05).In the anticoagulant treatment group,Mo CA scores were significantly increased in the rivaroxaban group compared to the warfarin group(Rivaroxaban vs.Warfarin Formation;20.87±3.93 vs.18.94±4.00,P<0.05),there were statistically significant differences between the time of atrial fibrillation and the time of medication(P<0.05).3.If Mo CA score ≥ 26,the patient is considered to have no cognitive dysfunction.If the Mo CA score is less than 26,the patient is considered to have cognitive dysfunction.According to whether the patients had cognitive dysfunction,they were divided into two groups for cognitive function univariate analysis.There were significant differences between the two groups in drug taking and education level(P<0.05).There were no significant differences in age,sex,body mass index,CHA2DS2-VASc score,HAS-BLED score,atrial fibrillation time,medication taking time,hypertension,diabetes,smoking history,drinking history,coronary heart disease,diabetes,heart failure,and related blood test results(P> 0.05).4.The significance of univariate analysis and factors(such as age)that may have an impact on cognitive function in clinical consideration were taken as independent variables,and the presence of cognitive dysfunction was taken as dependent variables for binary Logistic regression analysis,which proved that education level and drug use were independent risk factors for cognitive dysfunction in multifactor regression(P<0.05).After controlling for education level,the risk of cognitive impairment was reduced by 15.3% in the warfarin group and 75.7% in the rivaroxaban group compared with the control group.5.The score of each subitem of the Mo CA scale was compared among the three groups,and the score of visuospatial skill and executive ability and delayed recall in warfarin group were significantly lower than those in the other two groups(P<0.05).6.Serum vitamin K levels in the three groups were compared,and the data in the three groups did not obey normal distribution,and were described as median and quartile.The median vitamin K level was 0.380(0.355,0.398)ng/m L in the control group,0.338(0.325,0.345)ng/m L in the warfarin group,and 0.410(0.385,0.440)ng/m L in the Rivaroxaban group.The serum vitamin K level in warfarin group was significantly lower than that in the other two groups(P<0.05).Conclusion: 1.Compared with patients who did not take anticoagulant and antiplate drugs,patients who took anticoagulant drugs had a lower risk of cognitive dysfunction.In the anticoagulant group,patients treated with rivaroxaban had a lower risk of cognitive impairment than those taking warfarin.2.Compared with patients taking rivaroxaban,patients receiving warfarin treatment who are in a state of vitamin K deficiency may face a higher risk of cognitive impairment,especially worse performance in spatial skills,executive ability and memory ability. |
PDF Full Text Request