Warfarin Associated with Higher Rates of Dementia in Afib Patients. A study found that patients with atrial fibrillation, an abnormal heart rhythm that increases the risk for a blood clot, had a higher risk of dementia when taking the blood thinner warfarin compared to patients who do not have atrial fibrillation. Data was gathered from over 10,000 patients treated with warfarin. The study was conducted by researchers at the Intermountain Medical Center Heart Institute in Salt Lake City; findings were presented at the Heart Rhythm 2016, the Heart Rhythm Society’s 37th Annual Scientific Sessions in San Francisco earlier this year.
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Patients with atrial fibrillation experience an abnormal heart rhythm, which can increase the risk of a blood clot and subsequently increases the risk of a stroke. Atrial fibrillation can increase the risk of dementia because small blood clots can reach the brain and impair cognitive ability. Dementia is a neurological condition that affects memory and other cognitive tasks. Atrial fibrillation patients take blood thinners in order reduce the risk of all types of blood clots, some of which are life-threatening.
There were 10,537 participants in the study, and none had a history of dementia before the study began. All participants were given warfarin; some were prescribed the drug for atrial fibrillation and others took the blood thinner for other conditions that increase the risk of blood clots, such as valvular heart disease and thromboembolism. At a follow-up of seven years, the researchers found that patients with atrial fibrillation had a higher risk of all types of dementia compared to patients who did not have atrial fibrillation. For both patients with atrial fibrillation and those without, the risk of dementia rose as the time in therapeutic range was decreased or became erratic. Rates of dementia rose among both groups when warfarin levels were consistently too high or too low, researchers found. Dementia risk was highest among patients younger than 70 years, researchers found.
“Our study results are the first to show that there are significant cognitive risk factors for patients treated with Warfarin over a long period of time regardless of the indication for anticoagulation,” said lead author T. Jared Bunch, MD, director of heart rhythm research at Intermountain Medical Center Heart Institute and medical director for heart rhythm services for the Intermountain Healthcare system, according to Science Daily. The findings have important implications. “First, as physicians we have to understand that although we need to use anticoagulants for many reasons including to prevent stroke in AF patients, at that same time there are risks that need to be considered some of which we are only right now beginning to understand,” said Dr. Bunch. “In this regard, only those that absolutely need blood thinners should be placed on them long-term. Second, other medications like aspirin that may increase the blood thinners effect should be avoided unless there is a specific medical need. Finally, in people that are on Warfarin in which the levels are erratic or difficult to control, switching to newer agents that are more predictable may lower risk.”
Anticoagulant Lawsuits filed over Pradaxa, Xarelto, Eliquis
Parker Waichman comments that personal injury lawsuits have been filed over various blood thinners, particularly anticoagulants that emerged to replace warfarin. Drug injury claims have been filed over Pradaxa, Xarelto, Eliquis and other new generation blood thinners. Warfarin has been on the market for decades to reduce the risk of blood clots and stroke. The drug, which is sold under the brand name Coumadin, requires patients to undergo blood testing. Patients taking warfarin also have to avoid certain foods and medications. Newer anticoagulants do not have these limitations, but lawsuits point to another caveat; there is no antidote to reverse the drug’s blood thinning effects if necessary (such as during an emergency situation, when a patient bleeds excessively). If uncontrollable bleeding or hemorrhaging occurs in warfarin patients, doctors can give vitamin K to stop the drug’s blood thinning effects. Until recently, no such reversal agent existed for newer anticoagulants. Xarelto, Pradaxa and Eliquis lawsuits allege that drug makers were aware of this risk but failed to warn patients or their physicians. Blood thinner lawsuits typically allege uncontrollable, sometimes fatal bleeding, including gastrointestinal bleeding and brain hemorrhaging.