Dabigatran Versus Warfarin for Preventing Cognitive Decline in Older Patients With Atrial Fibrillation

A randomized, prospective trial in Brazil compared the efficacy of dabigatran and warfarin on cognitive and functional impairment, bleeding occurrence and cerebrovascular complications in older patients with atrial fibrillation (AFib). The trial researchers reported that dabigatran, when adequately used at the correct dosage for approximately two years, displayed no differences from warfarin in preventing cognitive decline. Their findings were presented at the American Heart Association’s Scientific Sessions 2021.


The study included 200 adults over age 70 with confirmed AFib. Participants were randomly assigned to take dabigatran 110 or 150 mg twice daily, or warfarin once daily, with dosage based on how long it takes the blood to clot, for two years. Participants completed 90-minute cognitive and functional evaluations at one-year and two-year follow-up visits. Patients also underwent a brain MRI at the end of the study to identify possible strokes.


Researchers found that no participants were diagnosed with dementia during the trial, supporting dabigatran’s efficacy in preventing cognitive decline. Additionally, there was a statistically insignificant difference in scores on scales measuring memory, executive functions, language, and attention from baseline between the warfarin and dabigatran groups.


“Cognitive aspects are important for patients with atrial fibrillation, and these results could help guide the decision about which oral anticoagulation medication should be prescribed,” said lead study author Bruno Caramelli, MD, associate professor of medicine at the University of Sao Paulo in Brazil. “Further studies are needed to explore new concepts on potential prevention of cognitive decline and the possible benefits of treatment for patients with atrial fibrillation and their families.”