Direct oral anticoagulants in atrial fibrillation patients with concomitant hyperthyroidism

Objective

Patients with hyperthyroidism were excluded from randomized clinical trials of direct oral anticoagulants(DOACs) for stroke prevention in patients with non-valvular atrial fibrillation (NVAF).

Methods

We performed a nationwide retrospective cohort study using data from the Taiwan National Health Insurance Research Database. We enrolled 3,213 and 1,181 NVAF patients with hyperthyroidism 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-based stabilized weights (PSSWs) to balance covariates across the study groups. We also used 1:4 matching on both taking DOACs, with (n=3,213) and without hyperthyroidism (n=12,852); and both taking warfarin, with (n=1,181) and without hyperthyroidism (n=4,724).

Results

After PSSW, DOAC had a comparable risk of ischemic stroke/systemic embolism (IS/SE) and a lower ...

目的：在针对非瓣膜性心房颤动（NVAF）患者卒中预防的直接口服抗凝剂（DOACs）随机临床试验中，甲状腺功能亢进患者被排除在外。

方法：本研究利用台湾全民健康保险研究数据库的数据开展全国性回顾性队列研究。2012年6月1日至2017年12月31日期间，我们分别纳入3213例和1181例合并甲状腺功能亢进且服用DOACs或华法林的NVAF患者，同时纳入53591例和16564例未合并甲状腺功能亢进且服用DOACs或华法林的NVAF患者。我们采用基于倾向评分的稳定权重（PSSWs）平衡各研究组间的协变量，还对服用DOACs的患者（合并甲状腺功能亢进者n=3213 vs 未合并者n=12852）及服用华法林的患者（合并甲状腺功能亢进者n=1181 vs 未合并者n=4724）进行1:4匹配。

结果：应用PSSWs后，DOACs的缺血性卒中/全身性栓塞（IS/SE）风险与[原文省略部分]相当，且[原文省略部分]风险更低...