Abstract

Abstract 1173

Background:

Among other side effects, hair loss is a frequent complaint in patients receiving anticoagulant therapy with Vitamin-K antagonists (VKA) and sometimes also found in patients receiving low-molecular weight heparin (LMWH). Novel oral anticoagulants (NOAC) such as apixaban, dabigatran or rivaroxaban have been tested in large prospective phase-III trials including over 100.000 patients. Furthermore, after approval more than one million patients have been treated with these novel drugs in daily care. So far, hair loss has not been reported as a side effect of NOAC therapy. Using data from a large monocentric prospective NOAC registry, we evaluated incidence and risk profile of newly reported hair loss in patients receiving dabigatran or rivaroxaban therapy.

Objectives:

To evaluate the incidence of newly reported hair loss as a potential side effect of NOAC therapy in daily care.

Patients and methods:

In the district of Saxony, Germany, a network of 200 physicians from private practice and hospitals enrol patients in the prospective NOAC registry. Inclusion criteria are: 1) indication for NOAC anticoagulation >3 month; 2) age > 18 years; 3) written informed consent; 4) availability for follow-up. No Exclusion criteria apply. In the registry, up to 2000 patients will receive prospective follow up (FU) by phone visits at day 30 day and quarterly thereafter to collect efficacy and safety data.

Results:

Until July 31th 2012, 938 patients were registered. Of these, 730 patients received rivaroxaban for atrial fibrillation (AF) or venous thromboembolism (demographic data in table 1) and 208 received dabigatran for AF. For these patients, current follow up data cumulate to 270.8 patient years of NOAC treatment. During follow-up visits, twelve patients spontaneously reported new hair loss (nine with rivaroxaban, 3 with dabigatran; demographic data in table 1). Therefore, total incidence of newly reported hair loss in our registry is 4.4 per 100 patient years. The mean time between start of NOAC and first report of hair loss was 68±76 days. Despite the fact that all twelve patients were female, uni- and multivariate analysis did not detect any correlation to baseline data including demographic data, co-morbidity or co-medication.

Conclusion:

In patients receiving long-term NOAC therapy, the incidence of hair loss as a spontaneously reported side effect is around 4.4 per 100 patient years. Before treatment initiation, patients should be informed about this potential side effect. Further data in larger cohorts are necessary to evaluate potential risk factors for hair loss with novel oral anticoagulants.

Table 1.

patient characteristics of 12 patients with newly reported hair loss during NOAC therapy. F=female; D=dabigatran, R= rivaroxaban; SPAF = stroke prevention in atrial fibrillation; VTE = venous thromboembolism

Agegender M/FNOACTotal daily dosage (mg)indicationTreatment duration until report of hair loss (days)diabeteshyper-tensionMalignant diseasealcoholsmoking
71 220 SPAF 183 – – – – 
77 300 SPAF 260 – – –  
73 220 SPAF 25 – – – – 
99 15 VTE 22 – – – – 
60 20 VTE 24 – – – – 
21 20 VTE 32 – – – – 
85 20 SPAF 30 – – – 
75 20 SPAF 34 – – – 
80 15 VTE 30 – – 
68 20 SPAF 25 – – – 
49 20 SPAF 68 – – – – 
79 30 VTE 87 – – – – 
Agegender M/FNOACTotal daily dosage (mg)indicationTreatment duration until report of hair loss (days)diabeteshyper-tensionMalignant diseasealcoholsmoking
71 220 SPAF 183 – – – – 
77 300 SPAF 260 – – –  
73 220 SPAF 25 – – – – 
99 15 VTE 22 – – – – 
60 20 VTE 24 – – – – 
21 20 VTE 32 – – – – 
85 20 SPAF 30 – – – 
75 20 SPAF 34 – – – 
80 15 VTE 30 – – 
68 20 SPAF 25 – – – 
49 20 SPAF 68 – – – – 
79 30 VTE 87 – – – – 
Disclosures:

Werth:Bayer Healthcare: Honoraria. Beyer-Westendorf:Bayer Healthcare: Bayer provided a grant to support the NOAC registry in part Other, Honoraria; Boehringer Ingelheim: Boehringer provided a grant to support the NOAC registry in part, Boehringer provided a grant to support the NOAC registry in part Other, Honoraria; Bristol Myers Squibb: Honoraria; Pfizer: Honoraria.

Author notes

*

Asterisk with author names denotes non-ASH members.