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.
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| http://dx.doi.org/10.1016/j.ijcha.2024.101401 | DOI Listing |
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