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Sagris, D, Ntaios, G, Buckley, BJR, Harrison, SL, Underhill, P, Lane, DA and Lip, GYH (2023) Direct oral anticoagulants are associated with lower risk of dementia in patients with atrial fibrillation. European Journal of Internal Medicine, 121. pp. 114-120. ISSN 0953-6205
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Abstract
BACKGROUND AND AIM: Atrial fibrillation (AF) is associated with increased risk of dementia. Whether direct oral anticoagulation (DOAC) reduce this risk compared to vitamin-K antagonist (VKA) is unclear. The aim of this study was to assess the risk of new all-cause dementia and vascular dementia in AF patients, treated with either DOAC or VKAs. METHODS: Anonymized electronic medical records from the TriNetX federated research network were used. AF patients treated with DOACs within 1 month of AF diagnosis, were 1:1 propensity score-matched with those treated with a VKA. The analysis included patients who completed 5 and 10 years of follow-up and were assessed for all-cause dementia and vascular dementia. Cox proportional hazard models were used to hazard ratios (HR), respectively with 95% confidence intervals (CIs). RESULTS: Among patients who completed 5 years of follow-up, after propensity score matching the final cohort consisted of 215,404 well-matched AF patients. All-cause dementia was diagnosed in 4,153 (3.9%) patients among those treated with DOACs and 4,150 (3.9%) among the VKA-treated patients (HR: 1.01, 95%CI: 0.96-1.05). Among patients 65-74 years old who were followed, DOAC treatment was associated with lower risk of dementia compared to VKAs (HR: 0.72; 95%CI: 0.59-0.86). Among patients who completed 10 years of follow-up, after propensity score matching the final cohort consisted of 19,208 well-matched AF patients. All-cause dementia was diagnosed in 314 (3.3%) patients among those treated with DOACs and 451 (4.7%) among the VKA-treated patients. DOAC treatment was associated with significantly lower risk of all-cause dementia during a follow-up period of 10 years compared to VKA treatment (HR: 0.72, 95%CI: 0.62-0.83), which remained consistent in patiens ≥65 years old. CONCLUSION: This propensity-score matched analysis showed that among AF patients, treatment with a DOACs for a period of 10 years was associated with lower risk of all-cause dementia and vascular dementia compared to VKA treatment, an effect which was not apparent in those treated for shorter duration. This finding requires confirmation in ongoing randomised controlled trials.
| Item Type: | Article |
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| Uncontrolled Keywords: | Atrial fibrillation; Dementia; Direct oral anticoagulation; Oral anticoagulation; Vitamin K antagonists; 1103 Clinical Sciences; General & Internal Medicine |
| Subjects: | Q Science > QP Physiology R Medicine > RM Therapeutics. Pharmacology |
| Divisions: | Nursing & Allied Health Sport & Exercise Sciences |
| Publisher: | Elsevier BV |
| SWORD Depositor: | A Symplectic |
| Date Deposited: | 03 Nov 2023 10:32 |
| Last Modified: | 06 Mar 2024 10:30 |
| DOI or ID number: | 10.1016/j.ejim.2023.10.033 |
| URI: | https://researchonline.ljmu.ac.uk/id/eprint/21784 |
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