HMN 2026: How Many older adults develop cardiovascular conditions that affect anti-amyloid treatment

A new study finds that a significant portion of older adults with mild cognitive impairment or dementia develop new cardiovascular diagnoses each year that may require treatment with anticoagulants or thrombolytics—medications that doctors often avoid during anti-amyloid monoclonal antibody therapy for Alzheimer’s disease due to increased bleeding risk.

Anti-amyloid monoclonal antibodies such as lecanemab and donanemab are among the newest therapies to modestly slow cognitive decline in people with Alzheimer’s disease, but they carry a risk of amyloid-related imaging abnormalities, or ARIA, a brain imaging signal that can sometimes represent bleeding in the brain. Clinical guidance generally recommends against prescribing anticoagulants or thrombolytic drugs concurrently with anti-amyloid monoclonal antibodies because of the risk of intracranial hemorrhage.

The findings offer important context for clinicians, patients, and caregivers as they weigh the potential benefits and risks of anti-amyloid treatments.

The study, “Risk of New Indications for Anticoagulants and Thrombolytics in People With Cognitive Impairment: Implications for Anti-Amyloid Therapy,” published in Neurology, analyzed data from 12,373 adults aged 65 and older who participated in the nationally representative Health and Retirement Study from 2010–2020. None had a prior indication for anticoagulant or thrombolytic therapy at baseline.

Participants were categorized into three groups based on cognitive status—normal, mild cognitive impairment, or dementia—using validated assessments and linked Medicare claims. The study estimated the one-year incidence of new cardiovascular diagnoses, including atrial fibrillation, deep vein thrombosis, pulmonary embolism, acute myocardial infarction, and stroke.

The research team quantified exactly how often these medical “collisions” occur:

• Among people with mild cognitive impairment, the study estimated that within one year, about 5.7% developed a new condition that could indicate a need for anticoagulant or thrombolytic therapy.
• For those with dementia, the corresponding one-year risk was approximately 6.7%.

The findings highlight that over the course of a year, a notable share of older adults with cognitive impairment or dementia may develop cardiovascular conditions for which anticoagulant or thrombolytic therapy is standard. Because current anti-amyloid treatment recommendations discourage anticoagulants or thrombolytics during therapy to avoid intracranial bleeding, these risks may factor into shared decision-making before starting such treatments.

“Our results provide national, real-world estimates of how often people with mild cognitive impairment or dementia develop conditions requiring anticoagulant or thrombolytic therapy,” said Dae Hyun Kim, MD, MPH, ScD, associate director and senior scientist at Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research. “This information can help clinicians and families better understand the potential trade-offs when considering anti-amyloid monoclonal antibody therapy, especially given the bleeding risk associated with these treatments.”

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