No effect of anticoagulation on cognitive decline in patients with AF at low risk of stroke

AHA 2024 – The objective of the BRAIN AF trial was to determine if OAC reduces cognitive decline in patients with AF at a low risk of stroke who do not have a current indication for OAC.

This summary is based on the presentation of Léna Rivard, MD, M.Sc. (Montreal, QC, Canada) at the AHA Scientific Sessions 2024 – Blinded Randomized Trial of Anticoagulation to Prevent Ischemic Stroke and Neurocognitive Impairment in Atrial Fibrillation (BRAIN AF)

Introduction and methods

Atrial fibrillation (AF) is associated with an increased risk of developing dementia and cognitive decline. Several observational studies showed that oral anticoagulation (OAC) decreases the risk of dementia in patients with AF who have a current indication for OAC. The objective of the BRAIN AF trial was to determine if OAC reduces cognitive decline in patients with AF at a low risk of stroke who do not have a current indication for OAC. A total of 1235 patients with AF and a low risk of stroke were randomized 1:1 to rivaroxaban 15 mg daily or placebo. Patients underwent a Mini-Mental State Examination (MMSE) and Montreal Cognitive assessment (MoCA) at baseline. During the trial, participants underwent yearly cognitive assessment (MoCA) and at the end of the trial MMSE and MoCA were repeated. Mean follow-up was 3.7 (IQR 1.9-6.0) years. The primary composite endpoint was cognitive decline (defined by a ≥2-point reduction in MoCA score compared to baseline), stroke, or TIA (motor deficit or aphasia).

Main results

• There was no statistical difference in the primary outcome between groups (HR 1.10, 95%CI 0.86-1.40, p=0.46)
• There were also no statistical differences in major bleeding, fatal bleeding or all-cause death between treatment groups.

Conclusion

Among patients with AF at low risk of stroke who do not have a current indication for OAC, rivaroxaban 15 mg daily did not reduce the incidence of the combined endpoint of cognitive decline, stroke or TIA compared to placebo.

- Our reporting is based on the information provided at the ESC Congress 2024 -