DOACs Reduce Dementia Risk Versus Warfarin in A-Fib

THURSDAY, Sept. 7, 2023 (HealthDay News) -- For patients with atrial fibrillation (AF), the use of direct-acting oral anticoagulants (DOACs) significantly reduces dementia risk compared with warfarin, according to a systematic review and meta-analysis published online Sept. 5 in the Journal of the American College of Cardiology: Asia.

Khi Yung Fong, from the National University of Singapore, and colleagues conducted a systematic review of studies reporting comparisons of dementia incidence between patients treated with DOACs and warfarin for AF. Data were included for 10 studies with 342,624 patients.

The researchers found that compared with warfarin, DOACs were associated with a significantly lower risk for developing dementia (hazard ratio, 0.88); the association was significant for Asian patients (hazard ratio, 0.81) but not non-Asian patients. In subgroup analyses, similar significance was seen for propensity score-matched studies and patients aged 65 to 75 years, but not for patients aged 75 years and older. A lower mean age corresponded to significantly greater favoring of DOACs over warfarin. In a network meta-analysis, significant reductions were seen in dementia risk for rivaroxaban, apixaban, and dabigatran versus warfarin (hazard ratios, 0.854, 0.881, and 0.871, respectively).

"The use of DOAC in AF significantly reduces dementia risk compared with warfarin, particularly in Asian patients. The possible reversal of this effect with increasing age merits further randomized trials with long-term follow-up," the authors write.

One author disclosed ties to the pharmaceutical industry.

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