2023 Alzheimer's Association Research Grant (AARG)

Benefits and Burdens of Anticoagulation for Patients with AF and AD/ADRD

How can long-term care providers balance the benefits and disadvantages of blood-clotting medications?

Kapoor Alok, M.D.
University of Massachusetts Chan Medical School
Worcester, MA - United States

Background

Atrial fibrillation, an irregular and often very rapid heart rhythm, accounts for one-third of all strokes in older adults. Stroke occurs when blood flow to the brain is blocked, leading to inflammation and death of brain cells. Studies have shown that individuals who have had a stroke may also be at increased risk for Alzheimer’s. Atrial fibrillation may impact the risk of developing Alzheimer’s by reducing blood flow to the brain.

Many older adults in long-term care take anticoagulant medications that help prevent blood clots and reduce the risk of strokes. Some studies suggest that anticoagulant medications may also show promise in preventing and slowing the progression of dementia. However, these medicines may cause “nuisance bleeding” (such as hemorrhoidal or nose bleeding) in people that take them. Nuisance bleeding episodes in long-term care residents often require emergency medical care and can reduce an individual’s quality of life.

Research Plan

Dr. Kapoor and colleagues will study the benefits and disadvantages of anticoagulant medications for long-term care residents and then design a conversation guide to help long-term care providers discuss these medications with residents and their families. The researchers will use data from the Minimum Data Set and Medicare for residents in long-term care. These data will include demographic information, diagnoses, physical and cognitive function, and medication information. 

Dr. Kapoor’s team will assess the benefits of taking anticoagulant medications in this population, including for stroke prevention and slowing or preventing cognitive impairment. They will also assess disadvantages associated with these medications, including hospitalizations for bleeding and emergency medical visits. The researchers will  study how anticoagulant use impacts the different outcomes. 

Based on the results, as well as feedback from an expert advisory panel, Dr. Kapoor and colleagues will develop a conversation guide to help balance the benefits and disadvantages of anticoagulant use in long-term care residents. They will recruit long-term care providers from the Society for Post-Acute and Long-Term Care to test their conversation aid and provide feedback, which will be used to refine the conversation aid.

Impact

The results of this project may shed new light on rates of cognitive decline and nuisance bleeding events associated with taking anticoagulant medication in long-term care residents. Furthermore, this knowledge will be translated into an easy-to-use tool to assist long-term care providers.