Key result
DOACs show no dementia benefit over VKAs at 5 years in AF patients.
Why the study?
AF is associated with increased dementia risk, but whether DOACs reduce this risk compared to VKAs remains unclear.
Does DOAC treatment reduce the risk of all-cause dementia in patients with atrial fibrillation compared to VKA treatment?
Cohort (n=215,404)
Yes
Does DOAC treatment reduce the risk of all-cause dementia in patients with atrial fibrillation compared to VKA treatment?
Hazard Ratio: 1.01 (95% CI 0.96–1.05)
Absolute Event Rate: 3.9% vs 3.9%
Long-term (10-year) treatment with direct oral anticoagulants is associated with a significantly lower risk of all-cause and vascular dementia compared to vitamin-K antagonists in patients with atrial fibrillation.
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.
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Sagris et al. (2023) conducted a cohort in Atrial fibrillation (n=215,404). Direct oral anticoagulants vs. Vitamin K antagonists was evaluated on All-cause dementia at 5 years follow-up (HR 1.01, 95% CI 0.96-1.05). Among 215,404 matched AF patients, DOAC treatment did not reduce the risk of all-cause dementia at 5 years (HR 1.01), but was associated with a 28% lower risk at 10 years (HR 0.72) compared to VKAs.
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