Key result
Direct oral anticoagulants were associated with a lower risk of composite dementia outcomes compared with warfarin in patients with atrial fibrillation (OR 0.56; 95% CI 0.34-0.94; P=0.03).
Why the study?
Atrial fibrillation is linked to an increased risk of dementia, but evidence comparing direct oral anticoagulants versus warfarin for dementia prevention in this population remains sparse.
Do direct oral anticoagulants reduce the risk of dementia compared to warfarin in patients with non-valvular atrial fibrillation?
Meta-Analysis (n=611,069)
Do direct oral anticoagulants reduce the risk of dementia compared to warfarin in patients with non-valvular atrial fibrillation?
In patients with non-valvular atrial fibrillation, DOACs may be superior to warfarin in preventing dementia, though current evidence is of low certainty.
Answers are grounded in this paper and cite their sources.
May support preferring DOACs over warfarin in AF to lower dementia risk; leaves open need for randomized confirmation.
Atrial fibrillation (AF) is associated with an increased risk of dementia. Studies have shown the beneficial effects of anticoagulants in preventing dementia in this population. However, evidence around the use of direct oral anticoagulants (DOACs) versus warfarin in AF-related dementia prevention remains sparse. This systematic review and meta-analysis aimed to evaluate the use of DOACs versus warfarin in dementia prevention in this population. MEDLINE, EMBASE, PsycINFO, and the CENTRAL databases were systematically searched from its inception until May 2020. Nine studies (n = 611,069) were included for quantitative meta-analysis. DOACs use was associated with a lower risk of composite dementia outcomes compared with warfarin use [odds ratio (OR) 0.56, 95% confidence interval (CI) 0.34-0.94, P = 0.03]. No significant difference was found in subtypes of dementia (vascular dementia, Alzheimer's disease, and cognitive disorder) between both groups. No significant difference in the risk of composite dementia outcomes between the dabigatran and warfarin groups (OR 0.97, 95% CI 0.88-1.08, P = 0.61). Apixaban (OR 0.58, 95% CI 0.50-0.67, P < 0.00001) and rivaroxaban (OR 0.67, 95% CI 0.61-0.75, P < 0.00001) use were both associated with a significantly lower risk of composite dementia outcomes compared with warfarin use. Findings need to be interpreted with caution because of low certainty of evidence. In conclusion, this systematic review and meta-analysis of 9 comparative studies demonstrated the superiority of DOACs over warfarin in prevention of dementia in AF. Future prospective trials with adequate follow-up period are warranted to ascertain its causal relationship.
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Lee et al. (2020) conducted a meta-analysis in Non-valvular Atrial Fibrillation (n=611,069). Direct oral anticoagulants (DOACs) vs. Warfarin was evaluated on Composite dementia outcomes (OR 0.56, 95% CI 0.34-0.94, p=0.03). Direct oral anticoagulants were associated with a lower risk of composite dementia outcomes compared with warfarin in patients with atrial fibrillation (OR 0.56; 95% CI 0.34-0.94; P=0.03).
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