DOACs a safe, effective alternative to warfarin in NVAF patients with hyperthyroidism

Use of direct oral anticoagulants (DOACs) appears to be safe and effective among nonvalvular atrial fibrillation (NVAF) patients with concomitant hyperthyroidism, according to a recent study, noting the potential of DOACs as an alternative to warfarin in these individuals.

The investigators conducted a nationwide retrospective cohort study using data from the Taiwan National Health Insurance Research Database. A total of 3,213 and 1,181 NVAF patients with hyperthyroidism who were on DOACs and warfarin, respectively, were enrolled between 1 June 2012 and 31 December 2017. Some 53,591 and 16,564 NVAF patients without hyperthyroidism on DOACs and warfarin, respectively, were also included.

Propensity score stabilized weights (PSSWs) were used to balance covariates across the study groups. The investigators also matched 1:4 patients taking DOACs, with (n=3,213) and without hyperthyroidism (n=12,852), as well as those taking warfarin, with (n=1,181) and without hyperthyroidism (n=4,724).

DOACs showed a similar risk of ischaemic stroke/systemic embolism (IS/SE) and a lower risk of major bleeding (hazard ratio [HR], 0.65, 95 percent confidence interval [CI], 0.44–0.96; p=0.0295) compared with warfarin among patients with hyperthyroidism after PSSW.

The risks of IS/SE and major bleeding were comparable between patients with and without hyperthyroidism. However, NVAF patients with hyperthyroidism on warfarin had a lower risk of IS/SE than those without hyperthyroidism (HR, 0.61, 95 percent CI, 0.43–0.86; p=0.0050).

“Thromboprophylaxis with DOACs may be considered for such patients, and it is important to validate this finding in further prospective study,” the investigators said.