Key result
Oral anticoagulant use in AF is linked to ~41% lower incidence of dementia.
Why the study?
The study was conducted to compare the incidence rate of dementia between users and nonusers of oral anticoagulants in primary care patients with atrial fibrillation.
Does oral anticoagulant use reduce the incidence of dementia in patients with atrial fibrillation?
Cohort (n=18,813)
Yes
Does oral anticoagulant use reduce the incidence of dementia in patients with atrial fibrillation?
In patients with atrial fibrillation, oral anticoagulant use, particularly direct-acting oral anticoagulants, is associated with a significantly lower risk of incident dementia compared to non-use or warfarin therapy.
Supports OAC consideration for dementia risk in AF but should not yet change practice; leaves open causal benefit pending RCTs.
Background We compared the dementia incidence rate between users and nonusers of oral anticoagulants (OACs) in a large cohort of primary care patients with atrial fibrillation. Methods and Results We performed a retrospective study using an Australia‐wide primary care data set, MedicineInsight. Patients aged ≥18 years and newly diagnosed with atrial fibrillation between January 1, 2010, and December 31, 2017, and with no recorded history of dementia or stroke were included and followed until December 31, 2018. We applied a propensity score for 1:1 pair matching of baseline covariates and Cox regression for comparing the dementia incidence rates for OAC users and nonusers. Data were analyzed for 18 813 patients with atrial fibrillation (aged 71.9±12.6 years, 47.1% women); 11 419 had a recorded OAC prescription for at least 80% of their follow‐up time. During the mean follow‐up time of 3.7±2.0 years, 425 patients (2.3%; 95% CI, 2.1%–2.5%) had a documented diagnosis of dementia. After propensity matching, the incidence of dementia was significantly lower in OAC users (hazard ratio [HR], 0.59; 95% CI, 0.44–0.80; P <0.001) compared with nonusers. Direct‐acting oral anticoagulant users had a lower incidence of dementia than non‐OAC users (HR, 0.49; 95% CI, 0.33–0.73; P <0.001) or warfarin users (HR, 0.46; 95% CI, 0.28–0.74; P =0.002). No significant difference was seen between warfarin users and non‐OAC users (HR, 1.08; 95% CI, 0.70–1.70; P =0.723). Conclusions In patients with atrial fibrillation, direct‐acting oral anticoagulant use may result in a lower incidence of dementia compared with treatment with either warfarin or no anticoagulant.
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Bezabhe et al. (2022) conducted a cohort in Atrial fibrillation (n=18,813). Oral anticoagulants (OACs) vs. Non-use of oral anticoagulants was evaluated on Incidence of dementia (HR 0.59, 95% CI 0.44-0.80, p=<0.001). Oral anticoagulant use in patients with atrial fibrillation was associated with a 41% lower incidence of dementia compared with nonuse (HR 0.59).
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