Association of Oral Anticoagulant Type With Risk of Dementia Among Patients With Nonvalvular Atrial Fibrillation

• Type of Material: Article
• Authors: Nemin Chen, Emory University; Pamela L. Lutsey, University of Minnesota; Richard F. MacLehose, University of Minnesota; J'Neka S. Claxton, Emory University; Faye L. Norby, University of Minnesota; Alanna M. Chamberlain, Mayo Clinic; Lindsay G. S. Bengtson, Optum; Wesley T. O'Neal, Emory University; Lin Y. Chen, University of Minnesota; Alvaro Alonso, Emory University
• Language: English
• Date: 2018-11-06
• Publisher: Wiley Open Access: Creative Commons Attribution Non-Commercial
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The Authors and Mayo Clinic.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.118.009561
• Title of Journal or Parent Work: Journal of the American Heart Association
• ISSN: 2047-9980
• Volume: 7
• Issue: 21
• Start Page: e009561
• End Page: e009561
• Grant/Funding Information: Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health awards F32HL134290 (O'Neal), R01HL122200, and R01HL131579; the National Institute on Aging of the National Institutes of Health award R21AG058445; and the American Heart Association award 16EIA26410001 (Alonso).
• Keywords: WARFARIN; SAFETY; Science & Technology; atrial fibrillation; RIVAROXABAN; METAANALYSIS; dementia; DABIGATRAN; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; EFFICACY; APIXABAN; direct oral anticoagulant; STROKE; warfarin; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Background—Oral anticoagulants (OACs) in patients with atrial fibrillation (AF), in addition to reducing stroke risk, could also prevent adverse cognitive outcomes. The purpose of this study was to compare the risk of dementia incidence across patients with AF initiating different OACs. Methods and Results—We identified patients with nonvalvular AF initiating OACs in 2 US healthcare claim databases, MarketScan (2007–2015) and Optum Clinformatics (2009–2015). Dementia, comorbidities, and use of medications were defined on the basis of inpatient and outpatient claims. We performed head-to-head comparisons of warfarin, dabigatran, rivaroxaban, and apixaban in propensity score–matched cohorts. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) of incident dementia for each propensity score–matched cohort and meta-analyzed database-specific results. We analyzed 307 099 patients with AF from the MarketScan database and 161 346 from the Optum database, of which 6572 and 4391, respectively, had a diagnosis of incident dementia. The mean follow-up of each cohort ranged between 0.7 and 2.2 years. Patients initiating direct OACs experienced lower rates of dementia than those initiating warfarin (dabigatran: HR, 0.85; 95% CI, 0.71–1.01; rivaroxaban: HR, 0.85; 95% CI, 0.76–0.94; apixaban: HR, 0.80; 95% CI, 0.65–0.97). There were no differences in rates of dementia comparing direct OAC user groups (dabigatran versus rivaroxaban: HR, 1.02; 95% CI, 0.79–1.32; dabigatran versus apixaban: HR, 0.92; 95% CI, 0.63– 1.36; apixaban versus rivaroxaban: HR, 1.01; 95% CI, 0.86–1.19). Conclusions—Patients with AF initiating direct OACs experienced lower rates of incident dementia than warfarin users. No obvious benefit was observed for any particular direct OAC in relation to dementia rates.