Endocrine Connections (May 2022)
Efficacy and safety of anticoagulation in thyrotoxic atrial fibrillation: a systematic review and meta-analysis
Abstract
Background: Evidence on the efficacy and safety of anticoagulation in preven ting stroke and thromboembolic events in people with thyrotoxic atrial fibri llation is scarce. Objective: We evaluated the efficacy and safety of anticoagulation in peopl e with thyrotoxic atrial fibrillation. Methods: Our study protocol was published in the International Prospect ive Register of Systematic Reviews (registration no. CRD42020222782). Four d atabases and two systematic review registers were searched through 25 November 2 020 for interventional and observational studies comparing anticoagulation therapy with active comparators, placebo, or no treatment in people with thyrotoxic atrial fibril lation. 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 co ntrolled trial and eight cohort studies were ultimately included. Effect estima tes on the efficacy and safety of anticoagulation were extracted. Meta-analysis using t he inverse variance and random-effects methods was conducted on four cohort studies with 3443 participants and 277 events. Anticoagulation in people with thyrotoxic atria l 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 fib rillation if the CHA2DS2- VASc score exceeds 1 and when atrial fibrillation persists beyon d 7 days. Direct oral anticoagulants may be associated with fewer bleeding events tha n warfarin. Conclusions: Anticoagulation prevents ischemic stroke and systemic thromboe mbolism in people with thyrotoxic atrial fibrillation. Direct oral anticoag ulants may be associated with fewer bleeding events.
Keywords
