Comparative Effectiveness of Direct Oral Anticoagulants versus Vitamin K Antagonists on the Incidence of Dementia in Patients with Non-Valvular Atrial Fibrillation: A Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Introduction: Atrial fibrillation (AF) is an established independent risk factor for cognitive decline and dementia. While oral anticoagulation is known to mitigate this risk compared to no treatment, the comparative effectiveness of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) on cognitive outcomes remains a subject of ongoing investigation. This systematic review and meta-analysis aims to synthesize the current evidence comparing the effects of DOACs and VKAs on the incidence of dementia in patients with non-valvular atrial fibrillation (NVAF). Methods: A systematic literature search was conducted across PubMed, Google Scholar, Semantic Scholar, Springer, Wiley Online Library databases for randomized controlled trials and observational studies comparing DOACs with VKAs in adults with NVAF and reporting on incident dementia or other cognitive and clinical outcomes. The study was conducted in accordance with PRISMA guidelines. The primary outcome was incident all-cause dementia. Secondary outcomes included dementia subtypes (vascular, Alzheimer's), ischemic and hemorrhagic stroke, mortality, and major bleeding events. Adjusted hazard ratios (HRs) were pooled using a random-effects model. The Newcastle-Ottawa Scale was used to assess the risk of bias in observational studies. Results: A total of 16 observational cohort studies, encompassing over 1.5 million patients, were included in the final analysis. The pooled data demonstrated that treatment with DOACs was associated with a significantly lower risk of incident all-cause dementia compared to treatment with VKAs (Hazard Ratio 0.88, 95% Confidence Interval [CI] 0.80–0.98). The benefit was most pronounced for vascular dementia, where DOACs showed a significant risk reduction, whereas no significant difference was observed for Alzheimer's disease. Subgroup analyses revealed that the protective effect of DOACs was more evident in patients younger than 75 years (HR 0.86, 95% CI 0.81–0.92) and in Asian populations (HR 0.81, 95% CI 0.68–0.86). Consistent with their known safety profile, DOACs were associated with a significantly lower risk of intracranial hemorrhage (HR approximately 0.47) compared to VKAs Discussion: The findings suggest that the neuroprotective benefit of DOACs over VKAs is likely mediated through a more stable anticoagulation profile and a superior cerebral safety profile, particularly the marked reduction in both clinical and subclinical intracranial bleeding. The attenuated benefit in the elderly may reflect a higher burden of competing risks and non-AF-related dementia pathologies. The pronounced effect in Asian populations may be linked to pharmacogenomic factors affecting VKA metabolism. Conclusion: In patients with NVAF, the use of DOACs is associated with a lower incidence of dementia compared to VKAs. This finding supports the preferential use of DOACs, not only for their established stroke prevention efficacy and safety but also for their potential long-term cognitive benefits.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,016 | 0,036 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,021 | 0,040 |
| Bibliométrie | 0,007 | 0,007 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».