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Oral anticoagulant treatment and the risk of dementia in patients with atrial fibrillation: a population-based cohort study


Bezabhe, WM and Bereznicki, LR and Radford, J and Wimmer, BC and Salahudeen, MS and Garrahy, E and Bindoff, I and Peterson, GM, Oral anticoagulant treatment and the risk of dementia in patients with atrial fibrillation: a population-based cohort study, Journal of the American Heart Association, 11, (7) Article e023098. ISSN 2047-9980 (2022) [Refereed Article]

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Copyright Statement

2022 The Authors. Published on behalf of the American Heart Association, Inc., by WileyAttribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License, ( which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

DOI: doi:10.1161/JAHA.121.023098


Background: We compared the dementia incidence rate between users and nonusers of oral anticoagulants (OACs) in a large cohort of primary care patients with atrial fibrillation.

Methods and results: We performed a retrospective study using an Australia-wide primary care data set, MedicineInsight. Patients aged ≥18 years and newly diagnosed with atrial fibrillation between January 1, 2010, and December 31, 2017, and with no recorded history of dementia or stroke were included and followed until December 31, 2018. We applied a propensity score for 1:1 pair matching of baseline covariates and Cox regression for comparing the dementia incidence rates for OAC users and nonusers. Data were analyzed for 18 813 patients with atrial fibrillation (aged 71.912.6 years, 47.1% women); 11 419 had a recorded OAC prescription for at least 80% of their follow-up time. During the mean follow-up time of 3.72.0 years, 425 patients (2.3%; 95% CI, 2.1%-2.5%) had a documented diagnosis of dementia. After propensity matching, the incidence of dementia was significantly lower in OAC users (hazard ratio [HR], 0.59; 95% CI, 0.44-0.80; P<0.001) compared with nonusers. Direct-acting oral anticoagulant users had a lower incidence of dementia than non-OAC users (HR, 0.49; 95% CI, 0.33-0.73; P<0.001) or warfarin users (HR, 0.46; 95% CI, 0.28-0.74; P=0.002). No significant difference was seen between warfarin users and non-OAC users (HR, 1.08; 95% CI, 0.70-1.70; P=0.723).

Conclusions: In patients with atrial fibrillation, direct-acting oral anticoagulant use may result in a lower incidence of dementia compared with treatment with either warfarin or no anticoagulant.

Item Details

Item Type:Refereed Article
Keywords:atrial fibrillation, dementia, direct-acting oral anticoagulants, oral anticoagulants, warfarin
Research Division:Biomedical and Clinical Sciences
Research Group:Pharmacology and pharmaceutical sciences
Research Field:Clinical pharmacy and pharmacy practice
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health outcomes
UTAS Author:Bezabhe, WM (Dr Woldesellassie Bezabhe)
UTAS Author:Bereznicki, LR (Professor Luke Bereznicki)
UTAS Author:Radford, J (Professor Jan Radford)
UTAS Author:Wimmer, BC (Dr Barbara Wimmer)
UTAS Author:Salahudeen, MS (Dr Mohammed Salahudeen)
UTAS Author:Garrahy, E (Dr Edward Garrahy)
UTAS Author:Bindoff, I (Dr Ivan Bindoff)
UTAS Author:Peterson, GM (Professor Gregory Peterson)
ID Code:149254
Year Published:2022
Web of Science® Times Cited:6
Deposited By:Pharmacy
Deposited On:2022-03-21
Last Modified:2022-11-17
Downloads:23 View Download Statistics

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