Cognitive impairment, adverse events and mortality among elderly patients treated with long-term oral anticoagulation: A monocentric prospective study

Abstract

Oral anticoagulants (AC) represent the leading cause of iatrogenic morbimortality in France. AC are widely prescribed among the elderly. The assessment of the cognitive impairment (CI) is not included within the common thrombotic and bleeding risk scores. The objective of this study was to examine an association between CI and adverse events in patients receiving long term oral AC. A prospective monocentric cohort study was conducted in patients (> 60 years-old) on oral AC. Death, hemorrhages, falls, hospital readmission and thromboembolic events were collected over 6 months follow-up. Patients were included during an hospitalization for any medical or surgical condition and divided into three groups, according to their Mini Mental State Examination (MMSE): Group 1 (absence of CI) MMSE > 26, Group 2 (mild CI) 23 < MMSE < 27, Group 3 (significant CI) MMSE < 24. Regardless of the kind of oral AC, among 120 patients (mean age: 82,2 ± 8,8 years), the all-causes mortality ( n = 25) was significantly higher in the Group 3 ( n = 17, P = 0,006); this also applies to the incidence of falls ( n = 34, P = 0,009) or major hemorrhages ( n = 10, P = 0,023). There was no thromboembolic event. Minor hemorrhages and hospital readmissions were not different in the 3 groups. After 6 months of follow up, the cognitive impairment was associated with mortality, major hemorrhages and falls among the elderly receiving oral AC. A systematic assessment of cognitive functions of these patients seems to be essential to analyze the global risk and the risks related to the AC treatment.