Implications for clinical practice and future investigation
This study with the latest evidence underlined the important role of
OACs on the prevention of clinical stroke, but also of the silent
cerebral infarcts in patients with AF. While this result was unable to
support the use of OACs solely to prevent dementia.
Given the shortages of previously published studies and the
characteristic of long-term progression of dementia, future
investigation should include: i) well-designed RCTs with longer
follow-up in younger patients for direct comparison of OACs and no
treatment,34 or well-designed study taking
comprehensively cognitive test at baseline, adjusting for baseline and
time-varying confounding factors, and applying at least 1-year
observational window; ii) identifying the cause and effect relationship
among AF burden, dementia, and OAC use; iii) evaluating the effect of
the percentage of time at risk with access to OACs, rather than the
baseline prescription on the risk of dementia; iv) reporting the studies
performed in different races.