Cardiovascular Conditions May Impact Alzheimer’s Treatment with Anti-Amyloid Therapies

A new study reveals that a significant number of older adults with mild cognitive impairment or dementia are diagnosed with new cardiovascular conditions annually, potentially requiring treatments like anticoagulants or thrombolytics. These medications are often avoided during anti-amyloid monoclonal antibody therapy for Alzheimer’s disease due to an increased risk of bleeding.

Anti-Amyloid Therapies and Bleeding Risk

Anti-amyloid monoclonal antibodies, including lecanemab and donanemab, are emerging therapies designed to slow cognitive decline in early Alzheimer’s disease. Although, they carry a risk of amyloid-related imaging abnormalities (ARIA), which can sometimes indicate brain bleeding. As of this risk, clinical guidelines generally advise against using anticoagulants or thrombolytic drugs concurrently with these therapies to minimize the chance of intracranial hemorrhage.

Study Findings on Cardiovascular Diagnoses

The findings, published in Neurology, provide crucial context for clinicians, patients, and caregivers as they evaluate the benefits and risks of anti-amyloid treatments. The study analyzed data from 12,373 adults aged 65 and older who participated in the Health and Retirement Study between 2010 and 2020, none of whom had a prior require for anticoagulant or thrombolytic therapy.

Participants were categorized based on cognitive status – normal, mild cognitive impairment, or dementia – using established assessments and Medicare claims data. Researchers then estimated the one-year incidence of new cardiovascular diagnoses, including atrial fibrillation, deep vein thrombosis, pulmonary embolism, acute myocardial infarction, and stroke.

Incidence Rates of New Cardiovascular Conditions

The research quantified the frequency of these potential treatment conflicts:

• Mild Cognitive Impairment: Approximately 5.7% of individuals developed a new condition potentially requiring anticoagulant or thrombolytic therapy within one year.
• Dementia: Around 6.7% of those with dementia experienced a new cardiovascular diagnosis within the same timeframe.

Implications for Treatment Decisions

These findings underscore that a substantial proportion of older adults with cognitive impairment or dementia may develop cardiovascular conditions that typically warrant anticoagulant or thrombolytic therapy. Given the current recommendations against using these medications during anti-amyloid treatment to avoid intracranial bleeding, these risks should be carefully considered during shared decision-making with patients, and families.

“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.”

About the Study

The study, “Risk of New Indications for Anticoagulants and Thrombolytics in People With Cognitive Impairment,” was published in Neurology on March 11, 2026. The research was conducted by Anna L. Parks et al.

Source: Hinda and Arthur Marcus Institute for Aging Research