Does Oral Anticoagulant Type Influence the Risk of Dementia?

Pavankumar Kamat

October 19, 2021

Individuals with newly diagnosed atrial fibrillation (AF) receiving direct oral anticoagulants (DOACs) have a lower risk of incident dementia and mild cognitive impairment (MCI) than those receiving vitamin K antagonists (VKAs), a new study published in  Heart  suggests.

There is evidence of an association between oral anticoagulant (OAC) use in AF and a reduced incidence of dementia. While DOACs have demonstrated superior protection against stroke and embolism compared with VKAs in randomised trials, little is known about the influence of OAC type on the level of cognitive protection.

A historical cohort study included 39,200 first-time OAC users with newly diagnosed AF (median age, 76 years; 44.6% female) identified using electronic health record data from the UK Clinical Practice Research Datalink between 2012 and 2018.

At baseline, 53% of the participants were VKA users and 47% were DOAC users. The overall incidence rate of dementia in the study population was 16.5 per 1000 person-years. DOAC users had a 16% lower risk of incident dementia (aHR, 0.84; 95% CI, 0.73-0.98) and a 26% lower risk of incident MCI (aHR, 0.74; 95% CI, 0.65-0.84) compared with VKA users. The risk reductions with DOAC vs VKA remained consistent across various sensitivity analyses.

The authors stated: "While further evidence, including from randomised controlled trials, would strengthen this finding, it may be relevant to consider cognitive risk profile when prescribing OACs for AF among older individuals." They call for further research to better understand the mechanisms through which OACs modify dementia risk.

This article originally appeared on Univadis, part of the Medscape Professional Network.

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