Triptan initiation tied to higher risk of stroke and MI in patients with high-risk CV profile: JAMA

Denmark: A recent case-crossover study including 429,612 individuals revealed that triptan initiation is associated with a higher risk of myocardial infarction and ischemic stroke. The risk of an ischemic event after triptan initiation was very low for the individual patient with low background cardiovascular (CV) risk.
The results published in JAMA Neurology suggest that avoiding triptan treatment due to concern about triptan-associated ischemic events is rational in patients with a high-risk CV profile. Triptans are selective serotonin 1B/1D/1F agonists that are among the first-line treatment options for acute migraine attacks.
The study supports the current US Food and Drug Administration (FDA) recommendation that triptans should not be prescribed to patients with a history of transient ischemic attack, coronary artery disease, or stroke.
In patients with ischemic heart disease or previous myocardial infarction, triptans are contraindicated and caution is advised when prescribing these drugs to patients with vascular risk factors. However, controlled observational studies have either shown no association or lower risk, possibly owing to the channelling of triptans to individuals at low risk of cardiovascular outcomes, and there is no clarity on whether avoiding triptan treatment for these patients is meaningful.
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