Karolinska Institutet study links NOACs to slower cognitive decline in atrial fibrillation and Alzheimer's
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A Karolinska Institutet study of 7,308 people with atrial fibrillation and Alzheimer’s disease, published in the European Heart Journal, found that those treated with NOAC blood thinners experienced slower cognitive decline than patients on warfarin or no anticoagulants. NOAC users also had lower risks of death, stroke, blood clots and fractures, while warfarin was associated with a higher risk of major bleeding.
Study Design
Researchers at Karolinska Institutet used data from the Swedish national quality register SveDem and identified 7,308 people with both atrial fibrillation and Alzheimer’s disease. Participants were divided into three matched groups: those treated with NOACs, those receiving warfarin, and those using no anticoagulant medication. Cognitive function was tracked over time with the Mini-Mental State Examination (MMSE). The study was published in the European Heart Journal.
Cognitive Decline
People treated with NOACs showed a slower rate of cognitive decline than the warfarin and no-anticoagulant groups. The annual difference was just over 0.2 MMSE points. Maria Eriksdotter, professor at the Department of Neurobiology, Care Sciences and Society, said the treatment could improve blood flow and reduce small-scale brain damage. Nanbo Zhu, a researcher in the same department, said that even such an effect could influence cognitive function over a longer period.
Secondary Outcomes
NOAC use was also associated with lower risks of death, stroke, blood clots and fractures compared with no anticoagulant treatment. Warfarin was linked to lower risks of death, stroke and blood clots, but a higher risk of major bleeding. The authors noted the study is observational and cannot establish cause and effect; some patients may have switched medications during follow-up.
What's Next
Further observational and interventional studies are needed to confirm whether NOACs causally slow cognitive decline in Alzheimer’s patients. It remains unclear whether the 0.2 MMSE point annual difference is clinically meaningful over a decade or whether unmeasured factors explain the association.
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Karolinska Institutet study links NOACs to slower cognitive decline in atrial fibrillation and Alzheimer's
