Key result
DOACs are linked to ~31% lower dementia risk vs. warfarin in atrial fibrillation.
Why the study?
The study was conducted to evaluate the association of direct oral anticoagulants and warfarin with the incidence of dementia in patients with atrial fibrillation.
Do direct oral anticoagulants (DOACs) reduce the incidence of dementia compared to warfarin in patients with atrial fibrillation?
Meta-Analysis (n=447,644)
Do direct oral anticoagulants (DOACs) reduce the incidence of dementia compared to warfarin in patients with atrial fibrillation?
In patients with atrial fibrillation, treatment with DOACs (particularly rivaroxaban and apixaban) is associated with a significantly lower incidence of dementia compared to warfarin.
DOACs may lower dementia risk versus warfarin in AF; extends observational data but leaves causality and practice change open pending RCTs.
Objects: To evaluate the association of direct oral anticoagulants (DOACs) and warfarin with dementia incidence in atrial fibrillation (AF) patients. Methods: Relevant studies were retrieved in databases including Embase, PubMed, Cochrane, Web of Knowledge, and ClinicalTrials.gov. Meta-analysis was then conducted using Stata 12.0 software. Results: A total of 9 studies involving 447,644 AF patients were included. The results indicated that AF patients treated with DOACs had a lower incidence of dementia compared to those treated with warfarin (RR: 0.692, 95 % CI: 0.603-0.793, P = 0.000), This trend was observed in both age groups, <75 years old (RR: 0.770, 95 % CI: 0.639-0.929, P = 0.006) and ≥75 years old (RR: 0.858, 95 % CI: 0.756-0.973, P = 0.017), particularly in cases of Alzheimer's disease (RR: 0.798, 95 % CI: 0.684-0.932, P = 0.004) rather than vascular dementia (RR: 0.841, 95 % CI: 0.61-0.143, P = 0.269). Furthermore, patients taking rivaroxaban (RR: 0.680, 95 % CI: 0.624-0.741, P = 0.000) and apixaban (RR: 0.598, 95 % CI: 0.528-0.676, P = 0.000) instead of dabigatran (RR: 0.941, 95 % CI: 0.862-1.027, p = 0.17) exhibited a lower incidence of dementia than those took warfarin. Notably, AF patients taking rivaroxaban (RR: 0.75, 95 % CI: 0.67-0.84, P = 0.000) and apixaban (RR: 0.758, 95 % CI: 0.647-0.889, P = 0.001) had a lower incidence of dementia than those taking dabigatran, although the difference between trivaroxaban and apixaban was not statistically significant (RR:1.161, 95 % CI: 0.934-1.443, P = 0.018). Conclusions: AF patients treated with DOACs, particularly rivaroxaban and apixaban, showed a lower incidence of dementia compared to those treated with warfarin, with a notable disparity observed when compared to dabigatran.
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Zhang et al. (2024) conducted a meta-analysis in Atrial fibrillation (n=447,644). Direct oral anticoagulants (DOACs) vs. Warfarin was evaluated on Incidence of dementia (RR 0.692, 95% CI 0.603-0.793, p=0.000). Direct oral anticoagulants were associated with a significantly lower incidence of dementia compared to warfarin in patients with atrial fibrillation (RR 0.692, 95% CI 0.603-0.793, P=0.000).
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