Whether patients with atrial fibrillation (AF) and thyroid disease are clinically
distinct from those with AF and no thyroid disease is unknown. Furthermore, the effectiveness
of anticoagulation for prevention of AF-related thromboembolic events in patients
with thyroid disease has not been adequately studied. Patients enrolled in the Apixaban
for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation, which
compared apixaban with warfarin in patients with AF (n = 18,201), were categorized
by thyroid disease history at randomization (hypothyroidism, hyperthyroidism, and
no thyroid disease). Adjusted hazard ratios derived from Cox models were used to compare
outcomes by thyroid disease history. Associations between randomized treatment and
outcomes by thyroid disease history were examined using Cox models with interaction
terms. A total of 18,021/18,201 (99%) patients had available thyroid disease history
at randomization: 1,656 (9%) had hypothyroidism, 321 (2%) had hyperthyroidism, and
16,044 (89%) had no thyroid disease. When compared with those without a history of
thyroid disease, patients with hypo- or hyperthyroidism were more likely to be female
(60.4% vs 32.1%; 52.0% vs 32.1%; both p <0.0001). Patients with hypothyroidism were
older (73 vs 70 years, p <0.0001) and more likely to have had previous falls (8.7%
vs 4.3%, p <0.0001). There was no difference in clinical outcomes by thyroid disease
history. The benefit of apixaban compared with warfarin was similar regardless of
thyroid disease history (interaction p >0.10). In conclusion, despite differences
in baseline characteristics of patients with and without thyroid disease, their clinical
outcomes were similar. The benefit of apixban compared with warfarin was preserved
regardless of thyroid disease history.
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Article info
Publication history
Published online: August 07, 2019
Received in revised form:
July 25,
2019
Received:
May 9,
2019
Footnotes
Funding Source: The ARISTOTLE trial was funded by Bristol-Myers Squibb, Princeton, NC and Pfizer, Inc., New York, NY. The ARISTOTLE trial was designed and led by a steering committee that included representatives of the sponsors. The sponsor was not involved in the planning of the analysis presented herewith, the interpretation of the data, writing the manuscript, or in the decision to submit the manuscript for publication. Dr. Goldstein was also supported by NIH training grant T-32-HL069749-15.
ClinicalTrials.gov: NCT00412984.
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© 2019 Elsevier Inc. All rights reserved.
