Dabigatran as good as Warfarin for prevention of cognitive decline in elderly with AF

The study, known as GIRAF, (acronym for CoGnitive Impairment Related to Atrial Fibrillation) is a two-year randomized, multi-center, prospective trial in Brazil evaluating the effects of dabigatran and warfarin on cognitive and functional impairment, bleeding occurrence and cerebrovascular complications in older patients with atrial fibrillation.

This study included 200 adults over age 70 with confirmed atrial fibrillation, and about 62% of the study participants were male. Participants were randomly assigned to take dabigatran (110 or 150 mg twice daily) or warfarin (once daily, dose controlled based on how long it takes the blood to clot) for two years. Patients also had a brain MRI at baseline and after two years to identify possible strokes.

Participants completed 90-minute cognitive and functional evaluations at the one-year and two-year follow-up visits. Another MRI was performed at the end of the two-year study period to identify possible cerebrovascular events.

The researchers found that after two years:

• no participant was diagnosed with dementia during the trial, and,
• among the entire study population, there was less than a half point difference (statistically not significant) between study participants taking warfarin and those taking dabigatran on scales measuring memory, executive functions, language and attention from baseline.

These findings highlight the importance of adequate anticoagulation treatment to decrease cognitive decline in older atrial fibrillation patients. In addition, the GIRAF researchers concluded that among older patients with atrial fibrillation who were adequately treated with warfarin or dabigatran, there was no difference in cognitive outcomes after two years of treatment.

"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," Caramelli said. "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