Hair Loss on Warfarin

How common is it?

Hair loss is a known side effect of warfarin, but has hardly been studied [ref 1]. Solid data on how frequently it occurs, on its time-course, and on treatments are  not available. Mild hair loss appears to be common, severe hair loss uncommon, complete hair loss has not been reported. In some patients hair loss occurs because of the patient’s acute illness, i.e. the thrombotic event itself (and not because of initiation of warfarin therapy) and starts weeks to months after the acute event, and then slowly resolves. It can also be due to the patient’s underlying medical condition that led to the thrombotic event, particularly autoimmune disorders, such as SLE and antiphospholipid antibody syndrome.

The warfarin-associated hair loss may occur within weeks to months of starting warfarin, but has also been reported to occur after several years of therapy. In some patients it slows down in spite of continuation of warfarin. It has been found to be reversible, once warfarin is stopped.

How to treat it?

Little is known as to what to do to prevent or treat the hair loss. There is a report in the medical literature that Coenzyme-Q10 (= ubidecarenone), 30 mg per day, slowed and reversed the hair loss in 2 patients, in spite of continuation of warfarin therapy [ref 2]. If a person starts Coenzyme Q10, he/she should get an INR checked 3-4 days later and again approximately 10 days later to make sure that Coenzyme Q10 does not influence the INR (an increase in INR was observed in one of the 2 patients reported). Other treatment interventions, such as Biotin or Zinc tablets, have not been studied. I am not aware of any data on whether the drug Minoxidil helps with warfarin-associated hair loss.

If the hair loss is bothersome enough one should discuss switching the patient to a different anticoagulant, such as Pradaxa® (Dabigatran), a low-molecular-weight-heparin (Lovenox®, Fragmin®, Innohep®) or Fondaparinux (Arixtra®). However, low molecular weight heparins, as well as unfractionated heparin have also been reported to occasionally cause hair loss [ref 3-7]. I have not seen any reports whether Pradaxa® leads to hair loss.

References

1. Umlas J et al. Warfarin-induced alopecia. Cutis 1988;42:63-64.
2. Nagao T et al. Treatment of warfarin-induced hair loss with ubidecarenone. Lancet 1995;346:1104-1105.
3. Apsner R et al. Dalteparin-induced alopecia in hemodialysis patients: reversal by regional citrate anticoagulation. Blood 2001 May 1;97(9):2914-5.
4. Sarris E et al: Diffuse alopecia in a hemodialysis patient caused by a low-molecular-weight heparin, tinzaparin. Am J Kidney Dis. 2003 May;41(5):E15.
5. Barnes C et al. Alopecia and dalteparin: a previously unreported association. Blood 2000 Aug 15;96(4):1618-9.
6. Hirschboeck JS et al. Alopecia and other toxic effects of heparin and synthetic heparinoids. Am J Med Sci. 1954 Mar;227(3):279-82.
7. Wang YY et al. Enoxaparin-induced alopecia in patients with cerebral venous thrombosis. J Clin Pharm Ther. 2006 Oct;31(5):513-7.

For patients: This same information, written for non-health care professionals, can be found here.

Disclosure: I have no financial conflict of interest relevant to this blog entry.

Last updated: March 23^rd, 2011