Évaluation d'une faible dose d'anticoagulation dans la prévention des accidents vasculaires cérébraux et du déclin cognitif chez les sujets atteints de fibrillation auriculaire (BRAIN-AF)


Léna Rivard

Institut de cardiologie de Montréal


Domaine :  santé des populations

Programme chercheurs-boursiers-cliniciens  - Junior 1

Concours 2017-2018

Atrial fibrillation (AF), the most common arrhythmia worldwide, and dementia are considered major public health issues, and are associated with high morbidity and significant mortality. Their frequency is growing faster than the aging of the population. When AF develops, the upper chambers of the heart lose their normally synchronized contractions which leads to an irregular heartbeat (rapid and disorderly). Since blood in the atria does not empty completely, it is unable to clot. When a blood clot dislodges, an interruption of blood flow in the brain can occur (stroke). Guidelines were established in order to help doctors decide which patients with AF should be receiving anticoagulation for stroke prevention. For patients with a low risk of stroke, current guidelines recommend that no anticoagulation treatment be given. In patients at low risk of stroke, more evidence suggests the significant presence of silent ischemia (tiny clots that travel through the brain without causing clinical stroke).

Over time, the accumulation of silent ischemia lesions can lead to cognitive decline, which consists of changes to knowledge functions such memory, understanding, reasoning and attention. In the BRAIN-AF study, we hypothesize that low-dose anticoagulation (rivaroxaban 15 mg per day) compared to aspirin, would reduce the combined risk of the occurrence of stroke and cognitive decline. A randomized study of 6,396 patients will be recruited in Canada and international sites and followed for 35 5 years. To be eligible, patients must be between 30 to 61 years old and have no risk factors for stroke. If the hypothesis is confirmed, the BRAIN-AF study has the potential to change clinical practice and have an impact on the prevention of cognitive impairment and dementia in the general population.