Long-Term Population-Based Cerebral Ischemic Event and Cognitive Outcomes of Direct Oral Anticoagulants Compared With Warfarin Among Long-term Anticoagulated Patients for Atrial Fibrillation

Use of Vitamin K Antagonists and Brain Morphological Changes in Older Adults: An Exposed/Unexposed Voxel-Based Morphometric Study

“…These results were confirmed in three longitudinal studies reporting greater cognitive decline and executive dysfunction among those using VKA, even after adjustment for a history of atrial fibrillation and stroke [8-10]. The possibility of an adverse effect of VKAs on the brain was strengthened by the finding of abnormalities of the central nervous system in newborns exposed in utero to VKAs [11], and by a recent study showing smaller whole-brain volumes among older adults using VKA compared to those using no VKA [12].…”

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: What is the best practice?

“…Non‐vitamin K antagonist oral anticoagulant therapy may reduce the incidence of brain micro‐haemorrhage compared with VKAs, but whether NOACs improve long‐term cognitive function is currently unknown. A recent community‐based study provided some optimism in this regard and found that NOAC therapies were associated with lower stroke and dementia rates compared with warfarin . Considering the incidence of dementia in AF, only trials with large numbers of patients and extended long‐term follow‐up would be able to firmly establish the possible benefit of oral anticoagulation on the subsequent risk of cognitive decline.…”

“…Cognitive endpoints were not addressed in the recent large RCTs of OAC (oral anticoagulation: VKA or NOACs) for thromboprophylaxis in AF, with one exception, the Birmingham Atrial Fibrillation Treatment of the Aged Study (BAFTA) which reported better cognitive function in elderly patients receiving warfarin compared with aspirin . In retrospective observational studies the risk of dementia increased with poor management of VKA (a low TTR), whilst NOAC use was associated with lower risk for dementia compared with warfarin . Observational data on AF patients diagnosed with dementia consistently shows significant VKA underuse or discontinuation even post‐stroke, despite similar VKA‐related bleeding risk irrespective of the cognitive status.…”

Novel Therapeutic Target of Anticoagulation Therapy in Patients With Atrial Fibrillation ― Cognitive Decline and Dementia ―

“…The incidence of stoke or transient ischemic attack (adjusted hazard ratio [HR] 0.47, 95% CI 0.32-0.68) and major hemorrhage (adjusted HR 0.70, 95% CI 0.57-0.80) in patients treated with DOAC was significantly lower than in those treated with warfarin. 15 The long-term incidence of dementia in patients treated with DOAC was also lower than in those taking warfarin (0.3% vs. 0.7%, P=0.03). It seems hopeful, but all-cause death was not significantly different between the DOAC and warfarin groups.…”

“…It seems hopeful, but all-cause death was not significantly different between the DOAC and warfarin groups. 15 Because this study was observational, not a randomized clinical trial, 15 the effect of DOAC for dementia cannot be referred. Further research is necessary to confirm whether dementia can be a novel therapeutic target of anticoagulation therapy in patients with AF and to determine if DOAC is really beneficial for reducing cognitive decline and preventing new-onset dementia.…”