Background – Alzheimer’s disease (AD) is a multifactorial neurodegenerative disorder with important vascular and hemostatic alterations that should be taken into account during diagnosis and treatment. Objectives – This study evaluates whether anticoagulation with dabigatran, a clinically approved oral direct thrombin inhibitor with a low risk of intracerebral hemorrhage, ameliorates AD pathogenesis in a transgenic mouse model of AD. Methods – TgCRND8 AD mice and their wild type (WT) littermates were treated for one year with dabigatran etexilate or placebo. Cognition was evaluated using the Barnes maze, and cerebral perfusion was examined by arterial spin labeling (ASL). At the molecular level, western blot (WB) and histochemical analyses were performed to analyze fibrin content, amyloid burden, neuroinflammatory activity, and blood brain barrier (BBB) integrity. Results – Anticoagulation with dabigatran prevented memory decline, cerebral hypoperfusion, and toxic fibrin deposition in the AD mouse brain. In addition, long-term dabigatran treatment significantly reduced the extent of amyloid plaques, oligomers, phagocytic microglia, and infiltrated T cells by 23.7%, 51.8%, 31.3% and 32.2%, respectively. Dabigatran anticoagulation also prevented AD-related astrogliosis and pericyte alterations and maintained expression of the water channel aquaporin-4 (AQP4) at astrocytic perivascular endfeet of the BBB. Conclusions – Long-term anticoagulation with dabigatran inhibited thrombin and the formation of occlusive thrombi in AD, preserved cognition, cerebral perfusion, and BBB function and ameliorated neuroinflammation and amyloid deposition in AD mice. Our results open a field for future investigation on whether the use of direct oral anticoagulants might be of therapeutic value in AD.

Alzheimer's disease (AD) and cardiovascular disease (CVD) are strongly associated. Both are multifactorial disorders with long asymptomatic phases and similar risk factors. Indeed, CVD signatures such as cerebral microbleeds, micro‐infarcts, atherosclerosis, cerebral amyloid angiopathy and a procoagulant state are highly associated with AD. However, AD and CVD co‐development and the molecular mechanisms underlying such associations are not understood. Here, we review the evidence regarding the vascular component of AD and clinical studies using anticoagulants that specifically evaluated the development of AD and other dementias. Most studies reported a markedly decreased incidence of composite dementia in anticoagulated patients with atrial fibrillation, with the highest benefit for direct oral anticoagulants. However, sub‐analyses by differential dementia diagnosis were scarce and inconclusive. We finally discuss whether anticoagulation could be a plausible preventive/therapeutic approach for AD and, if so, which would be the best drug and strategy to maximize clinical benefit and minimize potential risks.

Background: Alzheimer’s disease (AD) is the most common cause of dementia. It is a multifactorial degenerative disease pathologically characterized by intracellular neurofibrillary tangles and extracellular deposition of amyloid. An early hemostatic dysregulation is also present and contributes to an increment in clot formation, leading to hypoperfusion, blood brain barrier disruption and neuronal loss. The detection of this prothrombotic state is of the upmost importance in diagnostic approaches to identify AD patients who would benefit from anticoagulation. Method: The aim of this project is to use an in vivo nanotracer for the detection of brain thrombi in an AD mouse model by fast pre-targeted positron emission tomography (PET) imaging. For that purpose, AD animals and their wild-type littermates were intravenously injected with the antiplatelet antibody against CD41 conjugated with transcyclooctene (TCO-antiCD41). Twenty-four hours later, [68Ga]core-doped iron oxide nanoparticles (NP) functionalized with tetrazine (TZ) were intravenously administered. TCO and TZ produce a rapid in vivo reaction by means of bioorthogonal chemistry, allowing to non-invasively evaluate platelets’ levels by PET. Two hours after [68Ga]NP-TZ injection, a static PET study of each mouse was acquired with a scanner for small animals (nanoScan® PET/CT, Mediso, USA). Finally, biodistribution assays of different organs after the PET study were performed. All PET images were analyzed by regions of interest and voxel-wise analyses. Conclusions: Our results provide a neuroimaging strategy to diagnose the prothrombotic state towards the personalization of anticoagulation treatment in AD patients.