Farès Moustafa1,2, Rémi Malhomme3, Bruno Pereira4, Alain Barres5, Jennifer Saint-Denis3,6, Frederic Dutheil3,7,8, Marie Batisse6,9, Jeannot Schmidt3,6. 1. Emergency Department, Clermont-Ferrand University Hospital, 58 Rue Montalembert, 63003, Clermont-Ferrand, France. fmoustafa@chu-clermontferrand.fr. 2. EA 4679, Université Clermont Auvergne, 63000, Clermont-Ferrand, France. fmoustafa@chu-clermontferrand.fr. 3. Emergency Department, Clermont-Ferrand University Hospital, 58 Rue Montalembert, 63003, Clermont-Ferrand, France. 4. Biostatistics Unit, DRCI, Clermont-Ferrand University Hospital, Clermont-Ferrand, France. 5. Department of Medical Information, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. 6. EA 4679, Université Clermont Auvergne, 63000, Clermont-Ferrand, France. 7. Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions (AME2P, EA 3533), Blaise Pascal University, Clermont-Ferrand, France. 8. School of Exercise Science, Australian Catholic University, Melbourne, VIC, Australia. 9. Department of Endocrinology, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Abstract
BACKGROUND: Several studies have suggested a link exists between L-thyroxine and the coagulation system, and, according to some drug interaction studies, L-thyroxine can potentiate the effect of warfarin. This study sought to assess whether thyroid hormone therapy could impact the risk of bleeding in patients receiving vitamin K antagonists (VKAs). METHODS: We conducted a monocentric, retrospective study on prospectively collected data from consecutive patients enrolled in the Registry of patient with AntiThrombotic agents admitted to an Emergency Department (RATED) database, and compared the hemorrhage rates (both major and nonmajor) of patients receiving treatment with and without L-thyroxine. Propensity score matching analysis was performed to reduce the differences between patients receiving L-thyroxine and those not receiving L-thyroxine in order to reassess bleeding outcomes in patients receiving VKAs. RESULTS: From January 2014 to June 2015, 1454 patients receiving VKAs were recruited into the RATED database. Overall, 187 patients (12.8%) received L-thyroxine. Patients receiving L-thyroxine were more likely to be female than those not receiving L-thyroxine (78.1 vs. 55%) and more likely to exhibit hypertension (65.5 vs. 55.7%; p = 0.015), but less likely to have history of myocardial infarction (9.6 vs. 16.6%; p = 0.022) or higher creatinine levels (96.1 vs. 112.1 μmol/L; p = 0.04). After propensity score matching, bleeding outcomes were not significantly different between patients receiving L-thyroxine and those not receiving L-thyroxine. CONCLUSIONS: Our study revealed no evidence that L-thyroxine could increase bleeding risk in patients receiving VKAs. However, physicians must be aware that patients with thyroid disease receiving VKA therapy could have other drug interactions, particularly with amiodarone therapy. CLINICALTRIALS. GOV NUMBER: NCT02706080.
BACKGROUND: Several studies have suggested a link exists between L-thyroxine and the coagulation system, and, according to some drug interaction studies, L-thyroxine can potentiate the effect of warfarin. This study sought to assess whether thyroid hormone therapy could impact the risk of bleeding in patients receiving vitamin K antagonists (VKAs). METHODS: We conducted a monocentric, retrospective study on prospectively collected data from consecutive patients enrolled in the Registry of patient with AntiThrombotic agents admitted to an Emergency Department (RATED) database, and compared the hemorrhage rates (both major and nonmajor) of patients receiving treatment with and without L-thyroxine. Propensity score matching analysis was performed to reduce the differences between patients receiving L-thyroxine and those not receiving L-thyroxine in order to reassess bleeding outcomes in patients receiving VKAs. RESULTS: From January 2014 to June 2015, 1454 patients receiving VKAs were recruited into the RATED database. Overall, 187 patients (12.8%) received L-thyroxine. Patients receiving L-thyroxine were more likely to be female than those not receiving L-thyroxine (78.1 vs. 55%) and more likely to exhibit hypertension (65.5 vs. 55.7%; p = 0.015), but less likely to have history of myocardial infarction (9.6 vs. 16.6%; p = 0.022) or higher creatinine levels (96.1 vs. 112.1 μmol/L; p = 0.04). After propensity score matching, bleeding outcomes were not significantly different between patients receiving L-thyroxine and those not receiving L-thyroxine. CONCLUSIONS: Our study revealed no evidence that L-thyroxine could increase bleeding risk in patients receiving VKAs. However, physicians must be aware that patients with thyroid disease receiving VKA therapy could have other drug interactions, particularly with amiodarone therapy. CLINICALTRIALS. GOV NUMBER: NCT02706080.
Authors: Donald Lloyd-Jones; Robert J Adams; Todd M Brown; Mercedes Carnethon; Shifan Dai; Giovanni De Simone; T Bruce Ferguson; Earl Ford; Karen Furie; Cathleen Gillespie; Alan Go; Kurt Greenlund; Nancy Haase; Susan Hailpern; P Michael Ho; Virginia Howard; Brett Kissela; Steven Kittner; Daniel Lackland; Lynda Lisabeth; Ariane Marelli; Mary M McDermott; James Meigs; Dariush Mozaffarian; Michael Mussolino; Graham Nichol; Véronique L Roger; Wayne Rosamond; Ralph Sacco; Paul Sorlie; Randall Stafford; Thomas Thom; Sylvia Wasserthiel-Smoller; Nathan D Wong; Judith Wylie-Rosett Journal: Circulation Date: 2010-02-23 Impact factor: 29.690
Authors: Jan Debeij; Suzanne C Cannegieter; Bregje van Zaane; Anton P van Zanten; Frits R Rosendaal; Victor E A Gerdes; Pieter H Reitsma; Olaf M Dekkers Journal: Eur Thyroid J Date: 2014-02-28