Embolic risk in atrial fibrillation that arises from hyperthyroidism: review of the medical literature

Tex Heart Inst J. 2011;38(3):225-8.

Abstract

Atrial fibrillation, the most common cardiac complication of hyperthyroidism, occurs in an estimated 10% to 25% of overtly hyperthyroid patients. The prevalence of atrial fibrillation increases with age in the general population and in thyrotoxic patients. Other risk factors for atrial fibrillation in thyrotoxic patients include male sex, ischemic or valvular heart disease, and congestive heart failure. The incidence of arterial embolism or stroke in thyrotoxic atrial fibrillation is less clear. There are many reports of arterial thromboembolism associated with hyperthyroidism, including cases of young adults without coexisting risk factors other than thyrotoxic atrial fibrillation. The use of anticoagulative agents to prevent thromboembolic sequelae of thyrotoxic atrial fibrillation is controversial: National organizations provide conflicting recommendations in their practice guidelines. Herein, we review the medical literature and examine the evidence behind the recommendations in order to determine the best approach to thromboembolic prophylaxis in patients who have atrial fibrillation that is associated with hyperthyroidism.

Keywords: Anticoagu-lants/administration & dosage; atrial fibrillation/drug therapy; clinical trials as topic; embolism/prevention & control; evidence-based medicine; heart diseases/physiopathology; hyperthyroidism/complications/epidemiology; randomized controlled trials as topic; risk factors; thromboembolism/prevention & control; thyrotoxicosis/complications.

Publication types

  • Review

MeSH terms

  • Anticoagulants / therapeutic use
  • Atrial Fibrillation / drug therapy
  • Atrial Fibrillation / epidemiology
  • Atrial Fibrillation / etiology*
  • Atrial Fibrillation / physiopathology
  • Embolism / epidemiology
  • Embolism / etiology*
  • Embolism / prevention & control
  • Humans
  • Hyperthyroidism / complications*
  • Hyperthyroidism / epidemiology
  • Practice Guidelines as Topic
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • Thyrotoxicosis / etiology

Substances

  • Anticoagulants