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Direct Oral Anticoagulants in Atrial Fibrillation Patients With Concomitant Hyperthyroidism.

  • Chan, Yi-Hsin1, 2, 3
  • Wu, Lung-Sheng1, 2
  • See, Lai-Chu4, 5, 6
  • Liu, Jia-Rou4
  • Chang, Shang-Hung1, 2, 7
  • Chao, Tze-Fan8, 9
  • Yeh, Yung-Hsin1, 2
  • Kuo, Chi-Tai1, 2
  • Lee, Hsin-Fu1, 2, 10, 11
  • Lip, Gregory Y H12
  • 1 Division of Cardiology, Chang Gung Memorial Hospital, Linkou, Taiwan. , (Taiwan)
  • 2 College of Medicine, Chang Gung University, Taoyuan, Taiwan. , (Taiwan)
  • 3 Microscopy Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan. , (Taiwan)
  • 4 Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan. , (Taiwan)
  • 5 Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan. , (Taiwan)
  • 6 Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan. , (Taiwan)
  • 7 Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou, Taiwan. , (Taiwan)
  • 8 Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. , (Taiwan)
  • 9 Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan. , (Taiwan)
  • 10 Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. , (Taiwan)
  • 11 New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei, Taiwan. , (Taiwan)
  • 12 Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
Published Article
The Journal of Clinical Endocrinology & Metabolism
The Endocrine Society
Publication Date
Sep 01, 2020
DOI: 10.1210/clinem/dgaa050
PMID: 32009154


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). 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). 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). 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. © Endocrine Society 2020. All rights reserved. For permissions, please e-mail: [email protected]

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