Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 23;11(5):e220166.
doi: 10.1530/EC-22-0166.

Efficacy and safety of anticoagulation in thyrotoxic atrial fibrillation: a systematic review and meta-analysis

Eng-Loon Tng  1 , Yee Sian Tiong  1 , Aye Thida Aung  1 , Nicole Ya Yuan Chong  2 , Zhemin Wang  2
Affiliations

Efficacy and safety of anticoagulation in thyrotoxic atrial fibrillation: a systematic review and meta-analysis

Eng-Loon Tng et al. Endocr Connect. .

Abstract

Background: Evidence on the efficacy and safety of anticoagulation in preventing stroke and thromboembolic events in people with thyrotoxic atrial fibrillation is scarce.

Objective: We evaluated the efficacy and safety of anticoagulation in people with thyrotoxic atrial fibrillation.

Methods: Our study protocol was published in the International Prospective Register of Systematic Reviews (registration no. CRD42020222782). Four databases and two systematic review registers were searched through 25 November 2020 for interventional and observational studies comparing anticoagulation therapy with active comparators, placebo, or no treatment in people with thyrotoxic atrial fibrillation. Random-effects meta-analysis and sensitivity analysis were performed. Quality of evidence was described using the GRADE framework.

Results: In the study, 23,145 records were retrieved. One randomized controlled trial and eight cohort studies were ultimately included. Effect estimates on the efficacy and safety of anticoagulation were extracted. Meta-analysis using the inverse variance and random-effects methods was conducted on four cohort studies with 3443 participants and 277 events. Anticoagulation in people with thyrotoxic atrial fibrillation reduced the risk of ischemic stroke and systemic thromboembolism by 3% (95% CI: 1-6%). Warfarin may prevent ischemic stroke in people with thyrotoxic atrial fibrillation if the CHA2DS2-VASc score exceeds 1 and when atrial fibrillation persists beyond 7 days. Direct oral anticoagulants may be associated with fewer bleeding events than warfarin.

Conclusions: Anticoagulation prevents ischemic stroke and systemic thromboembolism in people with thyrotoxic atrial fibrillation. Direct oral anticoagulants may be associated with fewer bleeding events.

Keywords: anticoagulation; atrial fibrillation; direct oral anticoagulants; stroke; thromboembolism; thyrotoxicosis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
ROB of observational studies.
Figure 3
Figure 3
ROB of the RCT.
Figure 4
Figure 4
Data table and forest plot of the meta-analysis.
Figure 5
Figure 5
Data table and forest plot of the sensitivity analysis.
See this image and copyright information in PMC

References

    1. Auer J, Scheibner P, Mische T, Langsteger W, Eber O, Eber B. Subclinical hyperthyroidism as a risk factor for atrial fibrillation. American Heart Journal 2001142838–842. (10.1067/mhj.2001.119370) - DOI - PubMed
    1. Frost L, Vestergaard P, Mosekilde L. Hyperthyroidism and risk of atrial fibrillation or flutter: a population-based study. Archives of Internal Medicine 20041641675–1678. (10.1001/archinte.164.15.1675) - DOI - PubMed
    1. Osman F, Franklyn JA, Holder RL, Sheppard MC, Gammage MD. Cardiovascular manifestations of hyperthyroidism before and after antithyroid therapy: a matched case-control study. Journal of the American College of Cardiology 20074971–81. (10.1016/j.jacc.2006.08.042) - DOI - PubMed
    1. Sawin CT, Geller A, Wolf PA, Belanger AJ, Baker E, Bacharach P, Wilson PW, Benjamin EJ, D’Agostino RB. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. New England Journal of Medicine 19943311249–1252. (10.1056/NEJM199411103311901) - DOI - PubMed
    1. Shimizu T, Koide S, Noh JY, Sugino K, Ito K, Nakazawa H. Hyperthyroidism and the management of atrial fibrillation. Thyroid 200212489–493. (10.1089/105072502760143863) - DOI - PubMed

LinkOut - more resources