Key result
Direct oral anticoagulant therapy was associated with a significant reduction in the risk of dementia compared with vitamin K antagonist therapy in patients with atrial fibrillation (HR 0.89).
Why the study?
Oral anticoagulation reduces dementia in atrial fibrillation, but whether DOACs differ from VKAs in this protective effect had not been compared.
Does DOAC therapy reduce the incidence of dementia in patients with atrial fibrillation compared to VKA therapy?
Meta-Analysis (n=1,175,609)
Does DOAC therapy reduce the incidence of dementia in patients with atrial fibrillation compared to VKA therapy?
Hazard Ratio: 0.89 (95% CI 0.8–0.99)
In patients with atrial fibrillation, DOAC therapy is associated with a modest but statistically significant reduction in the risk of incident dementia compared to VKA therapy, though the certainty of evidence is very low.
Should not yet prefer DOACs solely for dementia prevention; leaves open whether the association is causal.
Oral anticoagulation significantly reduces the incidence of dementia in atrial fibrillation patients. However, this protective effect has not been compared between Direct Oral Anticoagulants (DOAC) and Vitamin K antagonists' anticoagulants (VKA). We conducted an electronic search for potentially eligible studies through the bibliographic databases MEDLINE, CENTRAL, ClinicalTrials.gov, EMBASE and Web of Science. The outcome of interest was dementia. Random-effects meta-analysis was performed. Nine observational studies were included and 1,175,609 atrial fibrillation patients were enrolled. DOAC therapy was associated with a significant reduction when compared with patients under VKA therapy (hazard ratio 0.89; 95% confidence interval 0.80-0.99). The grade of confidence of our results was very low due to the risk of bias. DOAC therapy is associated with a significant decrease in the risk of dementia when compared with VKA therapy. However, the low certainty of the evidence along with the paucityof clinical trials dedicated to answering this important question underscores a need for global clinical research initiatives.
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Branco et al. (2023) conducted a meta-analysis in Atrial fibrillation (n=1,175,609). Direct oral anticoagulants (DOAC) vs. Vitamin K antagonists (VKA) was evaluated on Incidence of dementia (HR 0.89, 95% CI 0.80-0.99). Direct oral anticoagulant therapy was associated with a significant reduction in the risk of dementia compared with vitamin K antagonist therapy in patients with atrial fibrillation (HR 0.89).
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