Confirmed Risks for MI and CVA With Triptan Therapy

Triptans have been a first-line therapy for migraines for decades. These agents are extremely effective for abortive therapy, much more so than alternative pain medications like NSAIDs and opioids. However, these drugs are potent vasoconstrictors and have been shown to vasoconstrict both coronary and cerebral arteries.

As such, triptans have always carried a contraindication for use in patients with established coronary or cerebrovascular disease, and their use is cautioned in patients with risk factors like hypertension and diabetes. While prior observational data have failed to confirm that triptans increase the risk for stroke and myocardial infarction (MI), these studies were inherently biased by the warnings that steered away the at-risk patients from triptan therapy.

In this installment of Talking Therapeutics, we explore a new study that controls for this confounding by using each patient as their control.

Talking Point: Hazards Confirmed

All people in nationwide Danish registries from January 1995 through August 2022 who were initiating triptans and all the ischemic events that they experienced were identified. A total of 429,612 individuals were included, of which 11 (0.003%) had a MI with the first triptan prescription (odds ratio [OR], 3.3; 95% CI, 1.0-10.9), 18 (0.004%) had ischemic stroke (OR, 3.2; 95% CI, 1.3-8.1), and 35 (0.008%) had ischemic/nonspecified stroke (OR, 3.0; 95% CI, 1.5-5.9).

Talking Point: No Cause for Panic

While the odds ratios for both cerebrovascular accidents (CVA) and MI were higher after triptan therapy, the overall risks were still extremely low. The bulk of these events occurred in patients with risk factors and in those aged over 60. These findings confirm that triptans are safe to use in patients with a low-risk cardiovascular profile, and these medications should continue to be avoided in patients with a history of clinical atherosclerotic cardiovascular disease (ASCVD).