Arrhythmias & electrophysiologyCohort study
Oral anticoagulants, cognition, and clinical outcomes in atrial fibrillation and Alzheimer’s disease: a Swedish nationwide study
- Nationwide cohort study
- inverse probability of treatment weighting
- Swedish Registry for Cognitive/Dementia Disorders
Authors' conclusion
In patients with AF and AD, NOAC use was associated with modestly slower cognitive decline and more favourable effectiveness and safety profiles, compared to warfarin or no anticoagulation.
Study context
- Population
- Individuals with incident Alzheimer's disease (May 2007–December 2020) and pre-existing atrial fibrillation (AF), Sweden
- Participants
- 7,308 individuals
- Exposure
- NOAC vs warfarin vs no anticoagulation
- Non-usen = 3,341reference
- Warfarinn = 2,277
- NOACsn = 1,690
- Outcome
- Cognitive decline (Mini-Mental State Examination (MMSE))
Main finding
As reported in the abstract
Cognitive decline (difference in MMSE scores)
β, points/year
- NOACs vs Non-use
- 0.23 (95% CI 0.11–0.36)
- NOACs vs Warfarin
- 0.21 (95% CI 0.10–0.33)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| All-cause mortality — NOACs vs Non-use | 0.81 (0.72–0.91) | |
| All-cause mortality — Warfarin vs Non-use | 0.88 (0.80–0.97) | |
| Ischaemic stroke/systemic embolism — NOACs vs Non-use | 0.66 (0.53–0.82) | |
| Ischaemic stroke/systemic embolism — Warfarin vs Non-use | 0.85 (0.72–1.00) | |
| Ischaemic stroke/systemic embolism — NOACs vs Warfarin | 0.78 (0.62–0.98) | |
| 0.512Hazard ratio (log scale) |
All-cause mortality
- NOACs vs warfarin: non-significant reduction
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Major bleeding — NOACs vs Non-use | 1.05 (0.84–1.32) | |
| Major bleeding — Warfarin vs Non-use | 1.31 (1.09–1.56) | |
| Major bleeding — NOACs vs Warfarin | 0.80 (0.64–1.01) | |
| Fracture | 0.79 (0.64–0.97) | |
| 0.512Hazard ratio (log scale) |
Fracture
- NOACs vs warfarin: non-significant reduction
Original publication
Oral anticoagulants, cognition, and clinical outcomes in atrial fibrillation and Alzheimer’s disease: a Swedish nationwide study. Eur Heart J. Published 12 August 2026. doi:10.1093/eurheartj/ehag584
Summarised from the published abstract; every number is checked against it