Less Dementia With Oral Anticoagulation in Atrial Fibrillation

Study Questions:

Is use of oral anticoagulation (OAC) among patients with atrial fibrillation (AF) associated with a lower risk of dementia?

Methods:

Using a retrospective design, the authors studied all patients with hospital discharge diagnoses of AF and no prior diagnosis of dementia in Sweden between 2006 and 2014. They used a 1:1 propensity-matched design along with an intention-to-treat analysis to minimize potential confounding.

Results:

Among the 444,106 AF patients without a prior dementia diagnosis, 42.9% were treated with warfarin, 2.9% used a direct oral anticoagulant, and 54.3% were not given any OAC. Patients treated with OAC had a 29% lower relative risk of dementia than patients not treated with OAC therapy (1.14 vs. 1.79 per 100 patient-years; hazard ratio, 0.71; 95% confidence interval, 0.68-0.74). There was no difference in dementia risk between patients treated with warfarin and those treated with direct oral anticoagulants.

Conclusions:

The authors concluded that the risk of dementia is higher among AF patients not treated with OAC.

Perspective:

This study highlights two important facts about stroke prevention in AF. First, use of OAC therapy is relatively low (~50%), which has been seen in many other population-based studies. Second, use of OAC therapy may have benefits beyond stroke risk reduction. While the exact mechanism for reducing dementia risk is unknown and the absolute risk reduction is quite small, these results may help to convince some AF patients to use OAC therapy.


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