White Matter Integrity and Anticoagulant Use: Age-Stratified Insights from MRI Diffusion-Weighted Imaging

Apparent diffusion coefficient (ADC) values, derived from diffusion-weighted magnetic resonance imaging (DW-MRI), increase with age, reflecting microstructural changes in white matter integrity. However, factors beyond chronological aging may influence cerebral diffusion characteristics. We investigated whether anticoagulant use is associated with favorable white matter ADC profiles, suggesting preserved microvascular health. ADC values were analyzed in cerebral white matter across four age-defined adult cohorts (20–59 years). Minimum, mean, and maximum ADC values were extracted. Patients at the lowest and highest ends of the ADC spectrum within each group were identified. The prevalence of anticoagulant use was compared between groups, and a logistic regression model adjusted for age was used to assess the independent association between anticoagulant use and lower ADC values. Across all cohorts (n = 892), anticoagulated patients (n = 89) were significantly overrepresented among individuals with low ADC values consistent with younger diffusion profiles. Of the anticoagulated patients, 93.3% had ADC values below the lower cut-off limit. In contrast, only 30% of non-anticoagulated patients exhibited such profiles. Anticoagulant use was independently associated with low ADC values after adjusting for age (OR = 4.89, p < 0.0001). Anticoagulation is strongly associated with lower, more favorable ADC values in cerebral white matter, independent of age. These findings support the potential neuroprotective role of anticoagulants and suggest that diffusion MRI may serve as a surrogate marker for early microvascular brain health.