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However, this protective effect has not been compared between Direct Oral Anticoagulants (DOAC) and Vitamin K antagonists\u2019 anticoagulants (VKA).  We conducted an electronic search for potentially eligible studies through the bibliographic databases MEDLINE, CENTRAL, ClinicalTrials.gov, EMBASE and Web of Science. The outcome of interest was dementia. Random-effects meta-analysis was performed.  Nine observational studies were included and 1,175,609 atrial fibrillation patients were enrolled. DOAC therapy was associated with a significant reduction when compared with patients under VKA therapy (hazard ratio 0.89; 95% confidence interval 0.80\u20130.99). The grade of confidence of our results was very low due to the risk of bias.  DOAC therapy is associated with a significant decrease in the risk of dementia when compared with VKA therapy. However, the low certainty of the evidence along with the paucityof clinical trials dedicated to answering this important question underscores a need for global clinical research initiatives.<\/jats:p>","DOI":"10.1007\/s11239-023-02843-5","type":"journal-article","created":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T15:03:01Z","timestamp":1688569381000},"page":"474-484","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Direct oral anticoagulants vs vitamin K antagonist on dementia risk in atrial fibrillation: systematic review with meta-analysis"],"prefix":"10.1007","volume":"56","author":[{"given":"Diogo R.","family":"Branco","sequence":"first","affiliation":[]},{"given":"Mariana","family":"Alves","sequence":"additional","affiliation":[]},{"given":"Catarina","family":"Severiano E Sousa","sequence":"additional","affiliation":[]},{"given":"Jo\u00e3o","family":"Costa","sequence":"additional","affiliation":[]},{"given":"Joaquim J.","family":"Ferreira","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2520-5673","authenticated-orcid":false,"given":"Daniel","family":"Caldeira","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2023,7,5]]},"reference":[{"issue":"4","key":"2843_CR1","doi-asserted-by":"publisher","first-page":"e29","DOI":"10.1161\/CIR.0000000000000152","volume":"131","author":"D Mozaffarian","year":"2015","unstructured":"Mozaffarian D et al (2015) Heart disease and stroke statistics-2015 update: a report from the American Heart Association. 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JJF: received grants from GlaxoSmithKline, Grunenthal, Funda\u00e7\u00e3o MSD (Portugal), TEVA, MSD, Allergan, Novartis, Medtronic. He received consultancy fees from GlaxoSmithKline, Novartis, TEVA, Lundbeck, Solvay, BIAL, Merck-Serono, Merz, Ipsen, Biogen, Acadia, Allergan, Abbvie, Sunovion Pharmaceuticals, Zambon, Affiris. He also participated in advisory boards for Bial and expert testimony to Novartis. DB, MA, CS and JC do not have conflict of interests to report.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}