BACKGROUND: Patients with dementia might have higher risk for hemorrhagic complications with anticoagulant therapy prescribed for atrial fibrillation (AF). OBJECTIVE: This study assesses the risks and benefits of warfarin, antiplatelets, and no treatment in patients with dementia and AF. METHODS: Of 49,792 patients registered in the Swedish Dementia Registry 2007-2014, 8,096 (16%) had a previous diagnosis of AF. Cox proportional hazards models were used to calculate the risk for ischemic stroke (IS), nontraumatic intracranial hemorrhage, any-cause hemorrhage, and death. RESULTS: Out of the 8,096 dementia patients with AF, 2,143 (26%) received warfarin treatment, 2,975 (37%) antiplatelet treatment, and 2,978 (37%) had no antithrombotic treatment at the time of dementia diagnosis. Patients on warfarin had fewer IS than those without treatment (5.2% versus 8.7%; p < 0.001) with no differences compared to antiplatelets. In adjusted analyses, warfarin was associated with a lower risk for IS (HR 0.76, CI 0.59-0.98), while antiplatelets were associated with increased risk (HR 1.25, CI 1.01-1.54) compared to no treatment. For any-cause hemorrhage, there was a higher risk with warfarin (HR 1.28, CI 1.03-1.59) compared to antiplatelets. Warfarin and antiplatelets were associated with a lower risk for death compared to no treatment. CONCLUSIONS: Warfarin treatment in Swedish patients with dementia is associated with lower risk of IS and mortality, and a small increase in any-cause hemorrhage. This study supports the use of warfarin in appropriate cases in patients with dementia. The low percentage of patients on warfarin treatment indicates that further gains in stroke prevention are possible.

Aging Research Center Karolinska Institutet and Stockholm University Stockholm Sweden

Department of Clinical Pharmacology Karolinska University Hospital Stockholm Sweden

Department of Clinical Science and Education Södersjukhuset Stockholm Sweden

Department of Geriatric Medicine Karolinska University Hospital Stockholm Sweden

Department of Internal Medicine Neurology Section Södersjukhuset Stockholm Sweden

Department of Medicine Solna Karolinska Institutet Stockholm Sweden

Department of Neurobiology Care Sciences and Society Division of Clinical Geriatrics Karolinska Institutet Stockholm Sweden

Department of Neurobiology Care Sciences and Society Division of Neurogeriatrics Karolinska Institutet Stockholm Sweden

Department of Neurology University Medical Center Ljubljana Slovenia

Department of Public Health Sciences Karolinska Institutet Stockholm Sweden

Institute of Gerontology School of Health and Welfare Aging Research Network Jönköping University Jönköping Sweden

Medical Faculty University of Ljubljana Ljubljana Slovenia

National Institute of Mental Health Klecany Czech Republic

Polish Academy of Sciences Mossakowski Medical Research Center Warsaw Poland

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