The effect of hyperthyroidism on procoagulant, anticoagulant and fibrinolytic factors

Danka J.F. Stuijver; Bregje van Zaane; Erica Romualdi; Dees P.M. Brandjes; Victor E.A. Gerdes; Alessandro Squizzato

doi:10.1160/TH12-07-0496

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2012; 108(06): 1077-1088
DOI: 10.1160/TH12-07-0496

Review Article

Schattauer GmbH

The effect of hyperthyroidism on procoagulant, anticoagulant and fibrinolytic factors

A systematic review and meta-analysis

Danka J.F. Stuijver

¹Department of Internal Medicine, Slotervaart Hospital, Amsterdam, the Netherlands

²Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands

,

Bregje van Zaane

¹Department of Internal Medicine, Slotervaart Hospital, Amsterdam, the Netherlands

²Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands

,

Erica Romualdi

³Department of Clinical Medicine, University of Insubria, Varese, Italy

,

Dees P.M. Brandjes

¹Department of Internal Medicine, Slotervaart Hospital, Amsterdam, the Netherlands

²Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands

,

Victor E.A. Gerdes

¹Department of Internal Medicine, Slotervaart Hospital, Amsterdam, the Netherlands

²Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands

,

Alessandro Squizzato

³Department of Clinical Medicine, University of Insubria, Varese, Italy

› Author Affiliations

Abstract

Summary

Several coagulation and fibrinolytic parameters appear to be affected by thyroid hormone excess;however, the net effect on the haemostatic system remains unclear. We aimed to update our previous review and systematically summarise and meta-analyse the data by assessing the effects of thyrotoxicosis on the coagulation and fibrinolytic system in vivo. Data sources included MEDLINE (2006–2012), EMBASE (2006–2012), and reference lists. The sources were combined with our previous search containing studies from 1980–2006. Eligible studies were all observational or experimental studies. Two investigators independently extracted data and rated study quality. Weighted mean proportion and 95% confidence intervals were calculated and pooled using a fixed and a random-effects model. A total of 29 articles consisting of 51 studies were included, as in several articles more than one study was described. We included four intervention (before and after treatment in hyperthyroid patients), five cross-sectional (hyperthyroid subjects and euthyroid controls), and four experimental (before and after use of thyroid hormone in euthyroid subjects) medium/high quality studies for meta-analysis. We found that thyrotoxicosis shifts the haemostatic balance towards a hypercoagulable and hypofibrinolytic state with a rise in factors VIII and IX, fibrinogen, von Willebrand factor, and plasminogen activator inhibitor-1. This was observed in endogenous and exogenous thyrotoxicosis, and in subclinical as well as overt hyperthyroidism. We conclude that both subclinical and overt hyperthyroidism induce a prothrombotic state, which is therefore likely to be a risk factor for venous thrombosis.

Keywords

Thyrotoxicosis - Hyperthyroidism - Coagulation - fibrinolysis

Full Text

References

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