Am I nuts yet? Warfarin and me.

        As I walked past my TV the other day, I heard one of those twenty-something year old science columnists who frequently pose as medical experts, misinterpreting journal articles.  This 'expert' announced that a recent study has shown that being on the anticoagulant Warfarin may cause Alzheimers disease.  Having been on this medication for thirty-five years or so, I  slowed down long enough to ask myself, "am I nuts yet?"  I decided that I passed that test, in my own opinion, at least.  Then I asked myself why  people are being inappropriately exposed to this potentially damaging information?  Some folks are not doing their jobs.         
     Atrial fibrillation is the commonest sustained cardiac arrhythmia in this part of the  world.  The incidence increases greatly after the age of  65 so as the population ages it is becoming much more common.  Untreated, folks with atrial fibrillation (A. Fib) are victims of  stroke  and other thrombo-embolic (clotting) disorders much more frequently than the general population.  Fortunately, treatment with appropriate anticoagulants greatly reduces the incidence of these catastrophes.  Warfarin, is the most time-tested of this category of drugs and no one could dispute its efficiency in dramatically reducing the complications of  A.Fib.   So, when I hear some semi-educated commentator sewing doubts in the minds of hundreds of  thousands of patients benefiting from this  medication on  the basis  of one poorly designed study, I wonder just how much  harm they are doing.   Don't think this won't affect compliance, an aspect of treatment that is delicate at the best of times.   Physicians spend a great deal of valuable time and effort convincing patients of the importance of taking this medication and the necessity of monitoring the coagulability of the blood on a regular basis.  The consequences of not taking it responsibly or discontinuing it can have very grave consequences.   So when I see or hear some pinhead (and sometimes the pinheads are physicians) speak authoritatively about something that they are just opining about, as though it were established fact, I am naturally upset.  How many patients are going to  stop taking their meds on account of the unreliable information they are being fed?  Have producers, broadcasters and publishers no responsibility to at least see that the information they are disseminating is accurate?  Obviously not.
    So I decided to take a look at the source of this information.  To cut to the chase, after reviewing the literature there are so many confounders that the conclusions of the only one journal article that suggests that there may be a relationship between the drug warfarin and Alzheimers, is a very weak one and certainly not one to merit any change in an acknowledged very effective treatment.  Some of the other studies do note some increase in cognitive problems in patients with A.Fib probably due to the cerebrvascular thromboembolic phenomena associated with the disease.  The evidence would seem to suggest the incidence is somewhat higher in patients whose coagulability was outside the therapeutic range that protects from clotting, rather than being related to the Warfarin.
     Bottom line:  I intend to keep taking my Warfarin as prescribed.  If I'm getting a little nutty, (cognitively impaired, in medical lingo)  I don't think it's from Warfarin.