DOACs reduce risk for dementia in AF vs. warfarin, especially in Asian patients
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Key takeaways:
- Direct oral anticoagulants were linked with reduced risk for dementia compared with warfarin in patients with atrial fibrillation.
- The effect was strongest in Asian patients.
Compared with warfarin, direct oral anticoagulants were associated with reduced risk for dementia in patients with atrial fibrillation, particularly those from Asian populations, according to a systematic review and meta-analysis.
“Asian patients are more likely to be sensitive to vitamin K antagonism, which puts them at high risk for bleeding events, contributing to dementia development or a reduction in warfarin dose to subtherapeutic levels,” Vern Hsen Tan, MBBS, senior consultant in the department of cardiology at Changi General Hospital in Singapore, said in a press release. “Asians are also often a lower body weight compared to non-Asians, perhaps allowing the [direct oral anticoagulants] to exert supratherapeutic effects at a standard dose.”
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Tan and colleagues analyzed 10 studies of direct oral anticoagulants (DOACs) vs. warfarin covering 342,624 patients with AF requiring anticoagulation for stroke prevention. They also conducted a network meta-analysis to determine the risk for dementia between warfarin and individual DOACs.
In the overall cohort, compared with warfarin, DOACs were associated with reduced risk for dementia (HR = 0.88; 95% CI, 0.8-0.98; P = .017; I2 = 75%).
In Asian patients, the effect was more pronounced (HR = 0.81; 95% CI, 0.68-0.86), but it was not significant in non-Asian patients, Tan and colleagues found.
The results were consistent in a propensity score-matched analysis and in an analysis of patients aged 65 to 75 years, but were not statistically significant in an analysis of patients older than 75 years, according to the researchers.
Studies favored DOACs to a greater degree if patients’ mean age was younger, Tan and colleagues wrote.
Compared with warfarin, the following DOACs were associated with reduced risk for dementia: rivaroxaban (Xarelto, Janssen/Bayer; HR = 0.854; 95% CI, 0.763-0.955), apixaban (Eliquis, Bristol Myers Squibb/Pfizer; HR = 0.881; 95% CI, 0.778-0.997), and dabigatran (Pradaxa, Boehringer Ingelheim; HR = 0.871; 95% CI, 0.77-0.987), according to the researchers.
Results for edoxaban (Savaya, Daiichi Sankyo) vs. warfarin were not significant because edoxaban was included in only one study, but edoxaban had the numerically highest reduction in dementia risk compared with warfarin, Tan and colleagues wrote.
“Overall, the use of DOACs in AF significantly reduces dementia risk compared to warfarin,” Tan said in the release. “We would highly recommend DOACs for Asian patients, in particular, as they saw the most benefit of dementia reduction. Nevertheless, the data suggestion of a reversal of this benefit with increasing age warrants further study.”
Reference:
- DOACs reduce dementia risk in Asian AFib patients compared to traditional blood thinners. https://www.acc.org/About-ACC/Press-Releases/2023/09/05/17/22/DOACs-Reduce-Dementia-Risk-in-Asian-AFib-Patients-Compared-to-Traditional-Blood-Thinners. Posted Sept. 5, 2023. Accessed Sept. 7, 2023.
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