Direct oral anticoagulants are associated with lower risk of dementia in patients with atrial fibrillation

Sagris, D, Ntaios, G, Buckley, BJR ORCID: 0000-0002-1479-8872, Harrison, SL, Underhill, P, Lane, DA and Lip, GYH ORCID: 0000-0002-7566-1626 (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
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 and Advanced Practice Sport and Exercise Sciences
Publisher:	Elsevier BV
Date of acceptance:	24 October 2023
Date of first compliant Open Access:	3 November 2023
Date Deposited:	03 Nov 2023 10:32
Last Modified:	04 Jul 2025 16:15
DOI or ID number:	10.1016/j.ejim.2023.10.033
URI:	https://researchonline.ljmu.ac.uk/id/eprint/21784

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