Comparative impact of direct oral anticoagulants and vitamin K antagonists on cognitive function in atrial fibrillation patients: a systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to compare the impact of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) on cognitive function in patients with atrial fibrillation. In August 2024, multiple electronic databases were searched following a two-phase screening strategy. Meta-analyses were performed using RevMan version 5.4. Effect estimations were presented as risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous outcomes. Eleven studies published between 2018 and 2024 were included in this research. Cognitive function assessments show minimal changes between the groups. At 5 years, DOACs were associated with lower rates of intracerebral bleeding (0.9% vs 1.4%) and mortality (17.6% vs 25.1%), while the incidence of all-cause dementia was identical in both groups (3.9%). At 10 years, DOACs continued to demonstrate benefits, with a reduced incidence of vascular dementia (0.7% vs 1.2%), lower all-cause mortality (23.2% vs 34.2%), and a decreased incidence of all-cause dementia (3.3% vs 4.7%). Meta-analysis results indicate a significantly lower risk of stroke or systemic embolism with DOACs (pooled RR = 0.30; 95% CI, 0.26-0.34), while the pooled risk for all-cause death showed no significant difference between the groups (pooled RR = 0.44; 95% CI, 0.16-1.16). DOAC users exhibited a lower incidence of all-cause dementia and fewer adverse events, particularly in long-term follow-ups. As a result, DOACs may provide a safer profile and a minor cognitive advantage over VKAs.