Can direct oral anticoagulant reduce the risk of dementia?



Researchers have discovered that atrial fibrillation patients with the longest follow-up who are being administered with direct oral anticoagulants have shown they have a lower risk of incidence dementia as well as mild cognitive impairment (MCI) in comparison to their counterparts receiving vitamin K antagonists.


As we all know, the statistics around the impact of Alzheimers and Dementia are devastating with over 70,000 deaths per year in the United Kingdom alone. (Dementia Stats)


According to the study, evidence suggests an association between oral anticoagulant (OAC) use in AF and a reduction in incidence dementia. There is still little known about the impact of OAC type on the level of cognitive protection however DOACs have demonstrated superior protection against stroke and embolism compared with VKAs in randomised trials.


However, this is not the first time a study of this type has been undertaken. Previous studies reviewed 39,200 first-time OAC users (median age, 76 years; 44.6% female) with newly diagnosed AF, identified using electronic health record data from the UK Clinical Practice Research Datalink between 2012 and 2018. In this particular case, the study population were as follows: 53% of the participants at baseline were VKA users; 47% were DOAC users.


The results were clear to see for many. The incidence dementia rate within the study population overall was 16.5 per 1000 person-years. DOAC users had a 16% lower risk of incident dementia and a 26% lower risk of incident MCI compared with VKA users. The risk reductions with DOAC vs VKA remained consistent across various sensitivity analyses.


While this preliminary study shows promise, the authors commented on the trial, stating:

"While further evidence, including from randomised controlled trials, would strengthen this finding, it may be relevant to consider cognitive risk profile when prescribing OACs for AF among older individuals."


The authors have called for further research to investigate how OACs could modify the risk of dementia across the board. This cannot come soon enough as each day we are losing many loved ones to this disease.


REFERENCES: Cadogan SL, Powell E, Wing K, et al Anticoagulant prescribing for atrial fibrillation and risk of incident dementia Heart Published Online First: 13 October 2021. doi: 10.1136/heartjnl-2021-319672



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Dr Herbert Benson - The Summary of an Incredible Life

Herbert Benson was born on April 24th 1935 in New York and
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