Dementia risk in AF comparable between DOACs, warfarin

Atrial fibrillation (AF) patients receiving warfarin do not appear to be at higher risk of dementia compared with their counterparts treated with direct oral anticoagulants (DOACs), with only edoxaban being associated with a lower risk, according to a study. Meanwhile, DOACs seem more beneficial among older patients with stroke history.

The study drew data from the Korean nationwide claims database and included 72,846 oral anticoagulant-naïve patients with nonvalvular AF aged ≥40 years. Researchers used the inverse probability of treatment weighting method for the comparisons.

Of the patients, 25,948 were treated with warfarin and 46,898 with DOACs (17,193 with rivaroxaban, 9,882 with dabigatran, 11,992 with apixaban, and 7,831 with edoxaban). Over a mean follow-up of 1.3 years, dementia had a crude incidence rate of 4.87 per 100 person-years (1.20 per 100 person-years for vascular dementia and 3.30 per 100 person-years for Alzheimer dementia).

There were no significant differences noted in the risks of dementia, vascular dementia, and Alzheimer dementia between the warfarin and DOAC groups. However, subgroup analyses showed that DOAC conferred a protective effect on dementia compared with warfarin, specifically among patients aged 65–74 years (hazard ratio [HR], 0.815, 95 percent confidence interval [CI], 0.709–0.936]) and among those with prior stroke (HR, 0.891, 95 percent CI, 0.820–0.968).

Among the DOACs examined, only edoxaban was associated with a lower risk of dementia as compared with warfarin (HR, 0.830, 95 percent CI, 0.740–0.931).