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.