From the Guidelines
For patients with atrial fibrillation (AF) and hyperthyroidism, anticoagulation therapy should be initiated based on stroke risk assessment using the CHA₂DS₂-VASc score, regardless of whether the AF is caused by hyperthyroidism, as recommended by the most recent guidelines 1. The recommended anticoagulation approach follows standard AF guidelines while addressing the underlying thyroid condition.
- Key considerations include:
- Assessment of stroke risk using the CHA₂DS₂-VASc score
- Initiation of anticoagulation therapy for patients with a CHA₂DS₂-VASc score of 2 or higher in men or 3 or higher in women
- Preference for direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban, dabigatran, or edoxaban over warfarin, unless the patient has mechanical heart valves or moderate-to-severe mitral stenosis
- Concurrent treatment of the underlying hyperthyroidism with antithyroid medications, radioactive iodine, or surgery
- It is essential to continue anticoagulation for at least 4 weeks after restoration of euthyroid status and normal sinus rhythm due to the ongoing risk of thromboembolism during this transition period, as supported by previous guidelines 1.
- Long-term anticoagulation decisions should be based on the patient's CHA₂DS₂-VASc score rather than thyroid status alone, emphasizing the importance of individualized care and regular reassessment of stroke and bleeding risks 1.