You'll have to grill your doctor on this to see if the risk is acceptable to you.
http://www.upi.com/Health_News/2016/05/05/Widely-used-heart-drug-tied-to-dementia-risk/2171462482024/
People with the heart rhythm disorder atrial fibrillation may have a
heightened risk of developing dementia -- and the quality of their drug
treatment may play a role, a new study hints.
Specifically, researchers found, patients on the clot-preventing drug
warfarin showed a higher dementia risk if their blood levels of the
medication were frequently too high or too low.
And that was true not only for people with atrial fibrillation, but also for those using warfarin for other reasons.
Dr. Jared Bunch, the lead researcher on the study, said the findings
uncover two potential concerns: People with atrial fibrillation may face
an increased risk of dementia, independent of warfarin use, but
warfarin might also contribute to dementia if the doses are not optimal.
"If people's levels of warfarin were erratic, their dementia risk was
higher, whether they had AF or not," said Bunch, who was scheduled to
present his findings Thursday at the Heart Rhythm Society's annual
meeting, in San Francisco.
The results do not prove that either atrial fibrillation or warfarin
are to blame, according to Bunch, a cardiologist at Intermountain
Medical Center, in Murray, Utah.
But, he said, there is reason to believe that both could contribute
to dementia -- in part because of effects on blood flow to the brain.
Atrial fibrillation is a common arrhythmia, affecting about 3 million
U.S. adults, according to the Heart Rhythm Society. In it, the upper
chambers of the heart quiver instead of contracting efficiently. The
condition is not immediately life-threatening, but it can cause blood
clots to form in the heart. If a clot breaks free and lodges in an
artery supplying the brain, that can trigger a stroke.
Because of that, people with atrial fibrillation often take
medications that cut the risk of blood clots. Those include aspirin or
anticoagulants such as warfarin (Coumadin).
Warfarin is a tricky drug to take, Bunch explained: People need
regular blood tests to make sure their warfarin levels are in the
"therapeutic range" -- high enough to prevent clots, but low enough to
avoid internal bleeding. The doses typically have to be changed over
time.
According to Bunch, it's possible that patients with erratic warfarin
levels are more prone to "small clots" or "small bleeds" that could
affect the brain.
The findings are based on records from over 10,000 patients who were
on warfarin for atrial fibrillation or to prevent blood clots from other
causes.
Over six to eight years, almost 6 percent of the atrial fib patients
developed dementia, including Alzheimer's disease -- versus less than 2
percent of other warfarin patients.
People with atrial fib were generally older and in poorer health. But
even after Bunch's team accounted for that, the atrial fib patients had
more than double the risk of dementia than that other patients.
The quality of warfarin treatment also seemed to matter, whether patients had atrial fibrillation or not.
Compared with patients whose warfarin was in therapeutic range more
than 75 percent of the time, those who were usually out of range had 2.5
to four times the odds of developing dementia.
However, there are many reasons a patient could be out of therapeutic
range, said Dr. Gordon Tomaselli, chief of cardiology at Johns Hopkins
University in Baltimore, and a past president of the American Heart
Association.
So it's hard to pin the blame on warfarin management, according to Tomaselli, who was not involved in the study.
Still, he said it is plausible that both atrial fibrillation and erratic warfarin levels contribute to dementia.
A study that compared warfarin patients to those on newer
anticoagulant drugs could help sort out the medication's role, Tomaselli
said.
For now, Bunch had some advice for patients. "If you're doing well on warfarin, there's no reason to worry," he said.
In other cases, he added, closer monitoring and better management might help patients keep their warfarin levels in range.
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