Dementia risk among patients with atrial fibrillation treated with non-vitamin K vs. vitamin-K oral anticoagulants

Abstract

Abstract Background Atrial fibrillation (AF) is associated with increased risk of dementia. Whether the use of direct oral anticoagulats (DOAC) is associated with lower risk of dementia compared to vitamin-K antagonist (VKA) is unclear. Purpose The purpose of this study was to assess the risk of new all-cause dementia and vascular dementia in AF patients, treated with either DOAC or VKAs. Methods Anonymized electronic medical records from the TriNetX federated research network were used. AF patients treated with DOACs within 1 month of AF diagnosis, were 1:1 propensity score- matched with those treated with a VKA. Patients were followed up to 10 years for all-cause dementia and vascular dementia. Logistic regression and Cox proportional hazard models were used to calculate odds ratios (OR) and hazard ratios (HR), respectively with 95% confidence intervals (CIs). Results Among 321,282 patients included in the propensity-scored cohort [mean (SD) age 69.7 (±13.5) years; 138,593 (43.1%) female], dementia was diagnosed among 15,050 (4.7%) patients. Among patients treated with DOACs, all-cause dementia was diagnosed in 6,337 (3.9%) and 8,713 (5.4%) among those treated with VKA (OR:0.72, 95%CI:0.69-0.74). Vascular dementia was diagnosed in 1,188 (0.7%) patients treated with DOACs and 1,766 (1.1%) among the VKA-treated (OR:0.67, 95%CI:0.62-0.72). DOACs were associated with lower risk of all-cause dementia and vascular dementia compared to VKA (HR:0.85, 95%CI:0.82-0.88 and HR:0.82, 95%CI:0.76-0.88, respectively). Conclusions In this large propensity-score matched analysis, AF patients treated with a DOACs had significantly lower risk of all-cause dementia and vascular dementia compared to those treated with VKA. This finding requires confirmation in ongoing randomised controlled trials.