Resolution of warfarin-induced alopecia with conversion to apixaban

Abstract

Warfarin is frequently prescribed as a long-term anticoagulant in patients with end-stage kidney disease as direct oral anticoagulants undergo renal excretion. Anticoagulation is a rare cause of alopecia in adults and is thought to be due to the promotion of the 'resting phase' of hair follicles. In this case report, a prevalent haemodialysis female patient required long-term anticoagulation following a complex pulmonary embolus and dialysis access complications. After commencing warfarin therapy, the patient reported generalised loss and thinning of her hair. All other potential causes were excluded. Cessation of warfarin therapy and conversion to apixaban with close monitoring alleviated the hair loss. Warfarin therapy is a rare cause of alopecia but should be considered in patients on long-term anticoagulation when other diagnoses have been excluded. Hair loss has a profoundly negative impact on patient quality of life and should prompt investigation to determine the underlying cause.

Keywords: chronic renal failure; dialysis; haematology (drugs and medicines); renal system; unwanted effects / adverse reactions.

Figure 1

Linogram assessing the right femoral tunnelled dialysis catheter (outlined in blue). The filling defect and accumulation of contrast in the right common iliac vein, cranial to the line tip, is due to thrombus causing subtotal occlusion. Contrast is redirected to the pelvic collateral vessels.

Figure 2

Stages of hair follicle development and associated causes of hair loss.