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Table 1_Efficacy of anticoagulation therapy in elderly patients with clinically diagnosed Alzheimer’s disease and atrial fibrillation: a clinical outcomes study.docx Xinhui Wang (126681) Xinying Yang (144004) Yiman Huang (10167036) Peng Qian (2421241) Hongyan Duan (21665764) Cellular Interactions (incl. Adhesion, Matrix, Cell Wall) Alzheimer disease anticoagulants atrial fibrillation direct oral anticoagulants stroke Introduction<p>Clinically diagnosed Alzheimer’s disease (AD) and atrial fibrillation (AF) are prevalent in the elderly, and their co-occurrence presents a complex management dilemma, balancing stroke prevention against bleeding risks, particularly in the context of cognitive impairment. This real-world cohort study aimed to evaluate the clinical outcomes of anticoagulant therapy in elderly patients with AD and AF.</p>Methods<p>We analyzed data from 342 patients (mean age 78.5 years; 58.3% female) with non-valvular AF and AD. Patients were categorized into anticoagulant (n = 247; 72.2%) and non-anticoagulant (n = 95; 27.8%) groups, with direct oral anticoagulants (DOACs) used in 57.9% of treated patients. Over a mean follow-up of 2.1 years, outcomes were compared between groups.</p>Results<p>Anticoagulation was associated with a significantly lower incidence of ischemic stroke/systemic embolism (annualized rate 2.9% vs. 7.1%; hazard ratio [HR] = 0.35, 95% CI 0.17–0.73, p = 0.005) and all-cause mortality (6.3% vs. 15.1%; HR = 0.32, 95% CI 0.19–0.54, p < 0.001) compared to no anticoagulation. DOACs were superior to warfarin in preventing stroke/embolism (HR = 0.36, 95% CI 0.15–0.87, p = 0.022). While major bleeding was higher with anticoagulation (6.1% vs. 0.9%; HR = 4.31, 95% CI 1.02–18.19, p = 0.047), the critical risk of intracranial hemorrhage was not significantly increased (1.6% vs. 1.0%; HR = 0.46, 95% CI 0.11–1.98, p = 0.30), and DOACs demonstrated a safer profile versus warfarin for major bleeding (HR = 0.24, 95% CI 0.06–0.89, p = 0.034). Key predictors for bleeding and thromboembolism, for example, advanced age, previous stroke history, and high HAS-BLED scores, were identified.</p>Discussion<p>In conclusion, anticoagulation, particularly with DOACs, provides a favorable net clinical benefit by significantly reducing stroke and mortality without a marked increase in intracranial hemorrhage in elderly AD patients with AF, supporting its judicious use. Further prospective studies are warranted to refine personalized decision-making.</p>Systematic review registration<p>https://www.crd.york.ac.uk/PROSPERO/view/CRD420251271276, Identifier: CRD420251271276.</p> 2026-09-23T04:48:08Z Dataset Dataset 10.3389/fncel.2026.1874032.s001 https://figshare.com/articles/dataset/Table_1_Efficacy_of_anticoagulation_therapy_in_elderly_patients_with_clinically_diagnosed_Alzheimer_s_disease_and_atrial_fibrillation_a_clinical_outcomes_study_docx/33970579 CC BY 4.0