Magazine article Drug Topics

Small Study Shows Benefit of Warfarin for Cluster Headaches

Magazine article Drug Topics

Small Study Shows Benefit of Warfarin for Cluster Headaches

Article excerpt

ANTICOAGULATION THERAPIES

Chronic cluster headaches are debilitating for patients who experience them. Isolated case reports have shown remission of intractable chronic duster headache with use of anticoagulant therapy. Evidence is lacking from randomized controlled trials, however, on the role of oral anticoagulants in cluster headache. A recent randomized pilot study examined the effect of low-intensity anticoagulation with warfarin on chronic duster headache refractory to pharmacologic therapy.

Thirty-four patients with refractory chronic cluster headache received warfarin or placebo for 12 weeks. The target international normalized ratio (INR) for warfarin was between 1.5 and 1.9. Patients were crossed over from 1 treatment to the other after a washout period of 2 weeks. The occurrence of remission lasting 4 weeks or longer was the primary outcome measure.

During the warfarin period, 17 patients (50%) had remission for 4 weeks or longer vs. 4 patients (1 1.8%) during the placebo period (P=.004). During warfarin treatment, frequency, duration, and intensity of duster attacks were all significantly lower (PcOl).

The authors concluded that low-intensity anticoagulation with warfarin was associated with significantly higher incidence of remission and less impact of headache on the lives of patients compared with placebo. More study is needed, however, to define its place in therapy.

Source: Hakim SM. Warfarin for refractory chronic cluster headache: A randomized pilot study. Headache. 2011;51:713-725.

Warfarin and dental procedures: To hold or not?

A common question from dentists and patients is whether warfarin needs to be interrupted for various dental procedures. Among other investigations, one recent multicenter study found that dental extractions can safely be performed in anticoagulated outpatients without altering their ongoing anticoagulant therapy. Many dentists, however, remain hesitant to perform such procedures for these patients despite evidence suggesting their safety.

Publications outlining best management of patients on warfarin, a vitamin K antagonist (VKA), are available. The American College of Chest Physidans guidelines state, "In patients who are undergoing minor dental procedures and are receiving VKAs we recommend continuing VKAs around the time of the procedure and coadministering an oral prohemostatic agent." The British Committee for Standards in Haematology guidelines state, The risk of significant bleeding in patients on oral anticoagulants and with a stable INR in the therapeutic range 2-4 (i.e. <4) is very small and the risk of thrombosis may be increased in patients in whom oral anticoagulants are temporarily discontinued. …

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