Direct Oral Anticoagulants in Atrial Fibrillation Patients With Concomitant Hyperthyroidism

Abstract Objective Patients with hyperthyroidism were excluded from the randomized clinical trials of direct oral anticoagulants (DOACs) for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). Methods We performed a nationwide retrospective cohort study using data from the Tai...

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Bibliographic Details
Published in:The journal of clinical endocrinology and metabolism 2020-09, Vol.105 (9), p.2893-2904
Main Authors: Chan, Yi-Hsin, Wu, Lung-Sheng, See, Lai-Chu, Liu, Jia-Rou, Chang, Shang-Hung, Chao, Tze-Fan, Yeh, Yung-Hsin, Kuo, Chi-Tai, Lee, Hsin-Fu, Lip, Gregory Y H
Format: Article
Language:English
Subjects:
Administration, Oral
Adult
Aged
Aged, 80 and over
Anticoagulants
Anticoagulants (Medicine)
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
Atrial fibrillation
Atrial Fibrillation - complications
Atrial Fibrillation - drug therapy
Atrial Fibrillation - epidemiology
Bleeding
Cardiac arrhythmia
Clinical trials
Cohort Studies
Comorbidity
Databases, Factual
Embolism
Female
Fibrillation
Hemorrhage - chemically induced
Hemorrhage - epidemiology
Humans
Hyperthyroidism
Hyperthyroidism - complications
Hyperthyroidism - drug therapy
Hyperthyroidism - epidemiology
Ischemia
Male
Middle Aged
National health insurance
Online databases
Prevention
Retrospective Studies
Risk Factors
Stroke
Stroke (Disease)
Stroke - complications
Stroke - drug therapy
Stroke - epidemiology
Taiwan - epidemiology
Treatment Outcome
Warfarin
Warfarin - administration & dosage
Warfarin - adverse effects
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Summary:Abstract Objective Patients with hyperthyroidism were excluded from the randomized clinical trials of direct oral anticoagulants (DOACs) for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). Methods We performed a nationwide retrospective cohort study using data from the Taiwan National Health Insurance Research Database. We enrolled 3213 and 1181 NVAF patients with hyperthyroidism who were taking DOACs and warfarin, respectively, from June 1, 2012 to December 31, 2017. We also enrolled 53 591 and 16 564 NVAF patients without hyperthyroidism, taking DOACs and warfarin, respectively. We used propensity score stabilized weights (PSSWs) to balance covariates across the study groups. We also used 1:4 matching on both taking DOACs, with (n = 3213) and without hyperthyroidism (n = 12 852); and both taking warfarin, with (n = 1181) and without hyperthyroidism (n = 4724). Results After PSSW, DOAC had a comparable risk of ischemic stroke/systemic embolism (IS/SE) and a lower risk of major bleeding (hazard ratio [HR] 0.65; 95% confidential interval [CI], 0.44–0.96; P = 0.0295) than warfarin among patients with hyperthyroidism. There were comparable risks of IS/SE and major bleeding between those patients with and without hyperthyroidism. However, among patients taking warfarin, those with hyperthyroidism had a lower risk of IS/SE than those without hyperthyroidism (HR 0.61; 95% CI, 0.43–0.86; P = 0.0050). Conclusion Among NVAF Asian patients with concomitant hyperthyroidism, DOACs may be an effective and safer alternative to warfarin. Thromboprophylaxis with DOACs may be considered for such patients, and it is important to validate this finding in further prospective study.
ISSN:0021-972X
1945-7197
DOI:10.1210/clinem/dgaa050