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Will you do Botox or use injectable CGRP monoclonal antibodies in patients on anticoagulation?

If on warfarin, what is your INR cut-off for either therapy?
2 Answers
Mednet MemberInvited Expert
Neurology · UPMC
Answered on

I use Botox and injectable CGRP monoclonal antibodies in patients on anticoagulation. I do not check INR prior to using Botox if patients are on AC. I have been practicing headache medicine since 2013 and have never noticed increased bleeding in patients on AC during a Botox procedure. The injections are superficial and in areas that are easily compressible to stop the bleeding if it occurs. I think that subcutaneous injections with CGRP monoclonal antibodies are also safe in patients on AC, and...

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Mednet MemberInvited Expert
Neurology · Greater Boston Headache Center at Boston Advanced Medicine
Answered on

I have not done either in a patient on anticoagulation. If I had to, I would prefer the GCRP antibody because it involves only one injection as opposed to thirty-one. I prefer to do those injections in the abdomen and would make sure to apply good hemostasis. Of course, under those circumstances, we could also use eptinezumab intravenously.

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