A new study suggests that those that suffer from the heart rhythm problem that is atrial fibrillation face a higher risk of dementia and it may be increased if the popular blood thinner and clot-preventing drug warfarin may make the risk even higher if not at optimal treatment levels.
Dementia – Warfarin levels are the key, not warfarin itself
Whether warfarin levels are too high or too low, it appears that you run a greater risk of dementia.
“If people’s levels of warfarin were erratic, their dementia risk was higher, whether they had AF or not,” said Dr. Jared Bunch who was the lead researcher of the story and presented his findings yesterday at the Heart Rhythm Society’s annual meeting, in San Francisco.
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Bunch was quick to point out that his paper is by no means proof that warfarin use or atrial fibrillation (AF) increases the risk of dementia, but does believe they both do, indeed, contribute to dementia due to erratic blood flow to the brain.
It’s estimated that around 2.7 million people suffer from AF and there are 20 million people presently taking warfarin so this study of over 10,000 long-term warfarin users is quite significant.
After combing the data of the 10,000, a follow up was done after seven years and found that the dementia rates in those taking warfarin for AF was much higher than those taking the drug for other conditions; 5.8 percent compared with 1.6 percent, respectively.
Bunch and a team of researchers conducted the study at Intermountain Medical Center Heart Institute in Salt Lake City, UT.
“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,”says Bunch.
Warfarin is a tricky drug to take, prescribe
Bunch explains that warfarin (Coumadin) is a tough balance, the body needs enough to eliminate clotting but if too much is taken, internal bleeding is a genuine issue and a “therapeutic range” is a must, but also difficult.
And that’s the kicker, for patients and doctors alike. Bunch found that warfarin takers in the aforementioned therapeutic range over 75% of the time, didn’t have nearly the risk of dementia that were outside of this range.
“If you’re doing well on warfarin, there’s no reason to worry,” said Bunch dissociating his study from warfarin bashing.
“But if you’re someone whose warfarin doses have to be changed a lot,” Bunch said, “you could ask your doctor about alternatives.”
Those alternatives include newer anticoagulants dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis) and Bunch pointed out that each of these three is easier to prescribe than warfarin. Before any suggestions of impropriety are made against Bunch it should be noted that no monies funded the study from outside of the Institute and certainly none from the makers of the drugs mentioned.
The study shows a genuine association for a healthy level of warfarin goes a long ways. At the end of the day, patients can do themselves a tremendous favor according to Bunch by eating well, certainly not smoking or drinking to excess and getting enough exercise. While warfarin works it’s quite important to mitigate other behaviors that lead to and increased risk of heart disease and specifically atrial fibrillation.