DOI

10.21007/con.dnp.2026.0146

Faculty Advisor

Tracy McClinton, DNP, APRN, AGACNP-BC, HGET-C, EBP-C

Document Type

Poster

Publication Date

Spring 4-30-2026

Disciplines

Health and Medical Administration | Investigative Techniques | Medicine and Health Sciences | Nursing | Nursing Administration | Quality Improvement

Abstract

Purpose/Background

Atrial fibrillation and dementia frequently coexist in older adults, creating complex challenges for anticoagulation management. Although anticoagulation is recommended to reduce thromboembolic risk in atrial fibrillation, current clinical guidelines lack dementia specific recommendations. Resulting in uncertainty regarding optimal therapy in this population. The purpose of this scoping review was to examine and synthesize current evidence comparing mortality risk and adverse events associated with direct oral anticoagulants (DOACs) versus warfarin in adults age 65 and older with atrial fibrillation and dementia.

Methods

A scoping review was conducted using PRISMA-ScR methodology. Peer-reviewed articles published between 2019 and 2023 were identified through PubMed, CINAHL, Embase, and the Cochrane Library. Inclusion criteria consisted of studies involving adults ≥65 years with diagnosed atrial fibrillation and dementia receiving either DOAC or warfarin therapy. Ten studies, including systematic reviews, meta-analyses, and cohort studies met eligibility criteria and underwent rapid critical appraisal. Data were charted and synthesized across key outcomes, including mortality, bleeding events, dementia risk, and treatment related adverse events.

Results

Across the included studies, DOAC therapy was consistently associated with lower rates of major bleeding, intracranial hemorrhage, and anticoagulation-related complications compared to warfarin. Several studies also demonstrated reduced dementia risk or slower cognitive decline among DOAC users. Mortality outcomes varied, however; the overall evidence favored DOACs as a safer and more manageable anticoagulation option in older adults with cognitive impairment.

Implications for Nursing Practice

Findings support the preferential consideration of DOACs over warfarin in older adults with dementia and atrial fibrillation to reduce treatment complexity and adverse events. Advanced practice nurses play a critical role in individualized anticoagulation decision-making, caregiver engagement, and ongoing monitoring. This scoping review highlights the need for dementia specific anticoagulation guidelines and further high-quality research to inform evidence-based nursing practices.

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