Abstract Number: Esoc2026a1998 Comparative Risk of Dementia in Patients With Atrial Fibrillation Treated With Direct Oral Anticoagulants Versus Vitamin K Antagonists in Routine Clinical Practice

Abstract Background and aims Anticoagulant choice may influence dementia risk in patients with atrial fibrillation (AF). This study compared dementia incidence and major clinical outcomes among patients with AF treated with direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in a contemporary Spanish cohort. Methods This retrospective analysis used the BIG-PAC® database, a comprehensive electronic health record and claims database covering primary and specialist care for 2 million patients in Spain. Patients with AF newly prescribed DOACs or VKAs between 2017 and 2023 were included. Those with dementia diagnosis within 12 months before or within 180 days after first prescription were excluded. Inverse probability of treatment weighting (IPTW) adjusted for observed confounding. Adjusted hazard ratios for dementia risk were estimated using Cox proportional hazards models, and time to dementia onset was assessed using Kaplan-Meier curves. Results Among 14,531 eligible patients with AF (DOAC, 7768; VKA, 6763), dementia incidence was numerically higher in VKA (6.73/100 patient-years) vs DOAC users (4.30/100 patient-years). IPTW-matched analyses showed DOACs were associated with reduced risks for dementia, ischaemic stroke/systemic embolism, intracranial bleeding, myocardial infarction, and all-cause mortality (Figure 1). Kaplan-Meier curves showed DOAC vs VKA users had significantly delayed onset of all-cause dementia (Figure 2). Conclusions In this large real-world cohort of patients with AF, DOAC vs VKA use was associated with a significantly reduced risk of dementia and major clinical outcomes. These findings support preferential use of DOACs over VKAs for stroke prevention in patients with AF and suggest potential additional benefits, including a reduced risk of cognitive decline. Conflict of interest RSB reports meeting and travel support and consulting honoraria from Daiichi Sankyo. RW, XY, CC, and MU are employees of Daiichi Sankyo. SK is an employee of Cytel, Inc. IH, LLB, and MGM are employees of Atrys Health. XGM reports consulting fees and/or speaking honoraria from Amarin, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novartis, Novo Nordisk, and Sanofi-Regeneron Pharmaceuticals. Figure 1 - belongs to Results Figure 2 - belongs to Conclusions