Blood Thinners Ineffective in Reducing Cognitive Decline for Younger AFib Patients

The first large-scale trial of its kind has found that the anti-clotting medication rivaroxaban does not lower the risk of cognitive decline, stroke, or transient ischemic attack (TIA) in people younger than 65 with atrial fibrillation (AFib) but no other stroke risk factors. The study, presented at the American Heart Association's Scientific Sessions 2024, challenges the practice of prescribing blood thinners to younger AFib patients without additional risk factors.

The Blinded Randomized Trial of Anticoagulation to Prevent Ischemic Stroke and Neurocognitive Impairment in Atrial Fibrillation (BRAIN-AF) included over 1,200 adults with an average age of 53. Half of the participants received 15 mg of rivaroxaban daily, while the other half received a placebo. After an average follow-up of 3.7 years, researchers found no significant differences in cognitive decline, stroke, or TIA between the two groups.

Lead author Dr. Lena Rivard, an electrophysiologist at Montreal Heart Institute, stated, 'Our study supports current guidelines by confirming that younger people with AFib but no other risk factors for stroke have a low rate of stroke, and anticoagulation is not useful in reducing the risk of cognitive decline.' This finding is particularly important as AFib is the most common heart rhythm disorder in the U.S., with prevalence expected to more than double from 5.2 million in 2010 to 12.1 million in 2030.

The study's results have significant implications for clinical practice. Dr. Rivard noted that younger people with AFib tend to be overtreated with anticoagulant therapy, while older individuals who have indications for anticoagulation are often under-treated. The BRAIN-AF trial's findings support current treatment guidelines that do not recommend anti-clotting medications for those under 65 with no other stroke risk factors.

Despite the lack of benefit from anticoagulation therapy, the study revealed a high rate of cognitive decline during follow-up in younger adults with AFib. This observation raises questions about potential alternative interventions, such as AFib ablation, that could positively impact cognition in this population. Further research is needed to explore these possibilities and to better understand the mechanisms of cognitive decline in AFib patients.

As the prevalence of AFib continues to rise, these findings underscore the importance of evidence-based treatment approaches and highlight the need for continued research into cognitive health in AFib patients. Healthcare providers should carefully consider the risk-benefit profile of anticoagulation therapy for younger AFib patients and focus on promoting overall cognitive health through lifestyle modifications and regular physical activity.