NOACs Linked to Slower Cognitive Decline in Patients With A-Fib, Alzheimer Disease

FRIDAY, Sept. 4, 2026 (HealthDay News) — For patients with atrial fibrillation (AF) and Alzheimer disease (AD), non-vitamin K oral anticoagulants (NOACs) are associated with modestly slower cognitive decline, according to a study published online Aug. 12 in the European Heart Journal.

Nanbo Zhu, Ph.D., from the Karolinska Institutet in Stockholm, and colleagues examined the impact of NOACs on cognitive function and clinical outcomes among patients with AF and AD. Individuals were categorized according to anticoagulant use at baseline (3,341 nonusers, 2,277 warfarin users, and 1,690 NOAC users). The association between anticoagulant use and cognitive decline measured by the Mini-Mental State Examination (MMSE) was examined.

The researchers found that compared with nonusers and warfarin users, NOAC users exhibited significantly slower cognitive decline (difference in MMSE scores, β = 0.23 and 0.21 points/year, respectively). NOAC use was associated with significantly lower rates of mortality, ischemic stroke/systemic embolism, and fracture compared with nonuse of anticoagulants (hazard ratios, 0.81, 0.66, and 0.79, respectively), with no increased rate of major bleeding; warfarin use was associated with significantly lower rates of mortality and ischemic stroke/systemic embolism (hazard ratios, 0.88 and 0.85, respectively) and with an increased rate of major bleeding (hazard ratio, 1.31). NOAC use was associated with lower rates of ischemic stroke/systemic embolism and major bleeding compared with warfarin (hazard ratios, 0.78 and 0.80, respectively) and with nonsignificant reductions in mortality and fracture.

“The difference is modest for an individual patient from one year to the next, but over a longer period even such an effect could influence how cognitive function develops,” Zhu said in a statement.

One author disclosed ties to the pharmaceutical industry.

Abstract/Full Text