In atrial fibrillation epilepsy risk differs between oral anticoagulants: active comparator, nested case-control...

Area of Science:

• Cardiology
• Neurology
• Pharmacoepidemiology

Background:

• Atrial fibrillation (AF) is a known risk factor for cerebrovascular events, including brain infarction.
• Brain infarction can lead to the development of epilepsy.
• The comparative risk of epilepsy associated with different anticoagulant therapies in AF patients remains an important clinical question.

Purpose of the Study:

• To investigate the association between direct oral anticoagulants (DOACs) and epilepsy risk in patients with atrial fibrillation (AF).
• To compare the risk of epilepsy in AF patients treated with DOACs versus vitamin K antagonist phenprocoumon (PPC).

Main Methods:

• An active comparator, nested case-control study was conducted using German health insurance claims data (25 million individuals, 2004-2017).
• 227,707 AF patients initiating treatment with DOACs or PPC were analyzed.
• 1,828 cases of epilepsy were matched with 19,084 controls; analyses considered baseline CHA2DS2-VASc scores and history of stroke.

Main Results:

• Patients with AF treated with DOACs exhibited a significantly higher risk of epilepsy (OR 1.39, 95% CI [1.24; 1.55]) compared to those treated with PPC.
• This increased risk persisted even after excluding patients with prior ischemic stroke.
• In a separate cohort of patients with venous thromboembolism, the epilepsy risk associated with DOACs was less elevated (aOR 1.15, 95% CI [0.98; 1.34]).

Conclusions:

• Treatment with DOACs for atrial fibrillation is associated with an increased risk of epilepsy compared to phenprocoumon.
• The findings suggest a potential link between DOAC therapy and epilepsy development in AF patients.
• Covert brain infarction is hypothesized as a potential mechanism underlying the observed elevated epilepsy risk with DOACs.