Association of direct oral anticoagulants and warfarin with incidence of dementia in atrial fibrillation patients: A systematic review and meta-analysis

Objects

To evaluate the association of direct oral anticoagulants (DOACs) and warfarin with dementia incidence in atrial fibrillation (AF) patients.

Methods

Relevant studies were retrieved in databases including Embase, PubMed, Cochrane, Web of Knowledge, and ClinicalTrials.gov. Meta-analysis was then conducted using Stata 12.0 software.

Results

A total of 9 studies involving 447,644 AF patients were included. The results indicated that AF patients treated with DOACs had a lower incidence of dementia compared to those treated with warfarin (RR: 0.692, 95 % CI: 0.603–0.793, P = 0.000), This trend was observed in both age groups, <75 years old (RR: 0.770, 95 % CI: 0.639–0.929, P = 0.006) and ≥75 years old (RR: 0.858, 95 % CI: 0.756–0.973, P = 0.017), particularly in cases of Alzheimer's disease (RR: 0.798, 95 % CI: 0.684–0.932, P = 0.004) rather than vascular dementia (RR: 0.841, 95 % CI: 0.61–0.143, P = 0.269). Furthermore, patients taking rivaroxaban (RR: 0.680, 95 % CI: 0.624–0.741, P = 0.000) and apixaban (RR: 0.598, 95 % CI: 0.528–0.676, P = 0.000) instead of dabigatran (RR: 0.941, 95 % CI: 0.862–1.027, p = 0.17) exhibited a lower incidence of dementia than those took warfarin. Notably, AF patients taking rivaroxaban (RR: 0.75, 95 % CI: 0.67–0.84, P = 0.000) and apixaban (RR: 0.758, 95 % CI: 0.647–0.889, P = 0.001) had a lower incidence of dementia than those taking dabigatran, although the difference between trivaroxaban and apixaban was not statistically significant (RR:1.161, 95 % CI: 0.934–1.443, P = 0.018).

Conclusions

AF patients treated with DOACs, particularly rivaroxaban and apixaban, showed a lower incidence of dementia compared to those treated with warfarin, with a notable disparity observed when compared to dabigatran.