Oral anticoagulants and risk of dementia: a systematic review and meta-analysis of observational studies and randomized controlled trials

Pajaree Mongkhon, Abdallah Y. Naser, Laura Fanning, Gary Tse, Wallis C.Y. Lau, Ian C.K. Wong, Chuenjid Kongkaew

Research output: Contribution to journalReview ArticleResearchpeer-review

57 Citations (Scopus)

Abstract

Atrial fibrillation (AF) is a documented risk factor for dementia. However, it is unclear whether oral anticoagulant (OAC) treatment can reduce the development of dementia or cognitive impairment. We conducted a systematic review and meta-analysis of the association between OAC use and subsequent dementia development in AF patients by searching databases from their inception to February 2018 without language restriction. Six studies (one randomized controlled trial and five observational studies) met the inclusion criteria. The pooled adjusted risk ratios (RRs) suggested a protective effect of OAC use in reducing dementia risk (RR 0.79 [95% CI: 0.67 – 0.93], I2 = 59.7%; P = 0.005). Further, high percentage of time in therapeutic range (TTR) was associated with a decreased risk of dementia (RR 0.38 [95% CI 0.22-0.64], I2 = 81.8%; P < 0.001). Our results support the hypothesis that AF-related dementia may be due to silent brain infarcts and micro-embolism that could be prevented by OAC use. Future studies with prospective follow-up with direct comparison of vitamin K antagonists and direct oral anticoagulants are needed.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalNeuroscience and Biobehavioral Reviews
Volume96
DOIs
Publication statusPublished - Jan 2019

Keywords

  • Anticoagulant
  • Atrial fibrillation
  • Cognitive impairment
  • Dementia
  • Direct oral anticoagulants
  • Warfarin

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