Better adherence to antithyroid drug is associated with decreased risk of stroke in hyperthyroidism patients

Tsai

et al. 2021

Background: Patients with hyperthyroidism have higher risk of atrial fibrillation (AF). However, the risk of thromboembolic event in patients with hyperthyroidism-related AF is controversial. Objectives: The aim of the study was to examine the risk of thromboembolic events in AF patients with/without hyperthyroidism. Methods: The national retrospective cohort study enrolled AF population was derived from the Taiwan National Health Insurance Research Database. The comparison between the AF patients with clinical hyperthyroidism (HT-AF group) and AF patients without hyperthyroidism (nonthyroid AF group) was made in a propensity score matched cohort and in a real-world setting, of which, the CHA 2 DS 2 -VASc level was treated as a stratum variable. The outcomes were ischemic stroke and systemic thromboembolism. Results: There were 3,880 patients in HT AF group and 178,711 in non-thyroid AF group. After propensity score analysis, the incidence of thromboembolism event and ischemic stroke were lower in HT AF patients than non-thyroid AF patients (1.6 versus 2.2 events per 100 personyears; HR, 0.73; 95% CI, 0.64-0.82 and 1.4 versus 1.8 events per 100 person-years; HR, 0.74; 95% CI, 0.64-0.84, respectively) in the 4.3 ± 3.2 year follow up period. The differences persistently existed in those receiving anticoagulants or not. In AF patients without anticoagulants, the incidence densities of ischemic stroke/systemic thromboembolism were significantly lower in HT AF group than those in non-thyroid AF group at CHA 2 DS 2 -VASc scores ≤ 4 (HR, 0.41; 95% CI, 0.35-0.48, p < 0.001), while the differences disappeared in case of score ≥ 5 (HR, 0.80; 95% CI, 0.63-1.02, p = 0.071). Conclusion:Patients with HT AF had lower incidence of thromboembolic events as compared to non-thyroid AF patients. The threshold of CHA 2 DS 2 -VASc score for anticoagulation in AF patients with clinical hyperthyroidism should be further evaluated. Highlights• The incidence of thromboembolic event was different between hyperthyroidism-related atrial fibrillation (HT-AF) and non-thyroid AF patients. • Hyperthyroidism did not confer additional risk of thromboembolic event at CHA 2 DS 2 -VASc of ≤ 4. • The benefit of anticoagulation strategy in patients with hyperthyroidism-related AF should be further evaluated, especially at low CHA 2 DS 2 -VASc score.

Section: Introductionmentioning

confidence: 99%

Risk of Thromboembolism in Non-Valvular Atrial Fibrillation With or Without Clinical Hyperthyroidism

Tsai

et al. 2021

“…Similar results were found in patients with hypertension 21 and hyperthyroidism. 22 Previous research found that excessive oral medication not only reduced patients' drug adherence, but also further negatively affected their quality of life. 23 These studies suggest that clinicians should adopt sustained-release and compound preparations to reduce the number of times, types and dosage of medication, so as to improve patients' drug adherence and improve the therapeutic effect.…”

Section: Discussionmentioning

confidence: 99%

“…23 These studies suggest that clinicians should adopt sustainedrelease and compound preparations to reduce the number of times, types and dosage of medication, so as to improve patients' drug adherence and improve the therapeutic effect. 22,23 Studies on the treatment of various chronic diseases have found that large prescription quantity by physicians can increase patients' psychological burden, which is significantly negatively correlated with drug adherence. [24][25][26] Patients' poor medication adherence and unsatisfactory treatment effect lead indirectly to the increase of prescription quantity.…”

Section: Discussionmentioning

confidence: 99%

Predicting medication nonadherence risk in the Chinese type 2 diabetes mellitus population – establishment of a new risk nomogram model: a retrospective study

et al. 2021

Objective To investigate the risk factors of medication nonadherence in patients with type 2 diabetes mellitus (T2DM) and to establish a risk nomogram model. Methods This retrospective study enrolled patients with T2DM, which were divided into two groups based on their scores on the Morisky Medication Adherence scale. Univariate and multivariate logistic regression analyses were used to screen for independent risk factors for medication nonadherence. A risk model was then established using a nomogram. The accuracy of the prediction model was evaluated using centrality measurement index and receiver operating characteristic curves. Internal verification was evaluated using bootstrapping validation. Results A total of 338 patients with T2DM who included in the analysis. Logistic regression analysis showed that the educational level, monthly per capita income, drug affordability, the number of drugs used, daily doses of drugs and the time spent taking medicine were all independent risk factors for medication nonadherence. Based on these six risk factors, a nomogram model was established to predict the risk of medication nonadherence, which was shown to be very reliable. Bootstrapping validated the nonadherence nomogram model for patients with T2DM. Conclusions This nomogram model could be used to evaluate the risks of drug nonadherence in patients with T2DM.

“…Hyperthyroidism causes a proinflammatory, procoagulant state in acute phases [ 14 ], arterial remodelling, stiffness and atherosclerosis over longer terms [ 15 ]. The acute prothrombotic phase immediately following the diagnosis of hyperthyroidism might be a treatment window to prevent thromboembolism and other cardiovascular events [ 16 , 17 ]. The finding of the current study suggests the importance of prompt risk stratification for stroke and initiation of oral anticoagulation following the diagnosis of hyperthyroidism [ 18 ], as well as timely treatment of hyperthyroidism to prevent stroke [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Yearly Incidence of Stroke and Bleeding in Atrial Fibrillation with Concomitant Hyperthyroidism: A National Discharge Database Study

Zhang

Bisson

Fauchier

et al. 2022

JCM

Background: Hyperthyroidism is associated with atrial fibrillation (AF), and the latter is a major risk factor for stroke. Aim: We aimed to investigate the yearly incidence of stroke and bleeding in AF patients with and without concomitant hyperthyroidism from the French National Hospital Discharge Database. Methods: Admissions with AF between January 2010 and December 2019 were retrospectively identified and retrieved from the French national database. Incidence rates of ischaemic stroke and bleeding were compared in AF patients with and without concomitant hyperthyroidism. The associations of risk factors with ischaemic stroke were assessed by Cox regression. Results: Overall 2,421,087 AF patients, among whom 32,400 had concomitant hyperthyroidism were included in the study. During the follow-up (mean: 2.0 years, standard deviation SD: 2.2 years), the yearly incidence of ischaemic stroke was noted to be 2.6 (95% confidence interval CI: 2.5–2.8) in AF patients with concomitant hyperthyroidism, and 2.3 (95%CI: 2.3–2.4) in non-thyroid AF patients. Hyperthyroidism was noted as an independent risk factor for ischaemic stroke (adjusted hazard ratio aHR: 1.133, 95%CI: 1.080–1.189) overall, particularly within the first year of hyperthyroidism diagnosis (aHR 1.203, 95%CI 1.120–1.291), however, the association became non-significant in subsequent years (aHR 1.047, 95%CI 0.980–1.118). Major bleeding incidence was lower in the hyperthyroid AF group in comparison to the non-thyroid AF group (incidence ratio: 5.1 vs. 5.4%/year, p < 0.001). The predictive value of CHA2DS2VASc and HAS-BLED scores for ischaemic stroke and bleeding events, respectively, did not differ significantly between AF patients with or without concomitant hyperthyroidism. Conclusions: Hyperthyroidism seems to be an independent risk factor of ischaemic stroke in AF patients, particularly within the first year of hyperthyroidism diagnosis.