Abstract Background and aims Triptans are a mainstay of acute migraine therapy but are contraindicated after ischaemic stroke (IS) or myocardial infarction (MI) because of presumed vasoconstrictive effects. However, evidence for increased vascular risk after triptan exposure in these populations is limited. We assessed whether triptan use after IS or MI is associated with recurrent vascular events in patients with migraine. Methods We conducted a retrospective cohort study using electronic health record data from the TriNetX US Network (2003–2022). Adult migraine patients with prior IS were included. Triptan exposure during years 1–2 after IS was compared with no triptan exposure, with outcomes assessed during years 3–5. Propensity score matching balanced baseline characteristics. Corresponding analyses were performed in migraine patients with prior MI and in comparator cohorts exposed to non-steroidal anti-inflammatory drugs (NSAIDs). Results The cohort comprised 49,388 migraine patients with IS not treated with triptans (mean age 54.0±14.7 years; 74.5% female) and 2,001 treated with triptans (mean age 51.4±13.3 years; 84.2% female). Annual rates of recurrent IS were 2.74% in triptan-treated patients versus 3.24% in controls (RR 0.85; 95% CI 0.68–1.05). Rates of MI (0.32% vs 0.33; RR 0.96) and all-cause mortality (0.58% vs 0.75; RR 0.77) were similar. Triptan use was associated with a significant increase in typical side effects, whereas NSAID exposure was associated with increased risks of recurrent IS and MI. Findings were consistent in MI cohorts. Conclusions In this large real-world cohort, triptan use after IS or MI was not associated with increased vascular risk. Conflict of interest Georg Royl received compensation from Cardinal Health 200 LLC for consultant services, compensation from Novartis Pharma AG for other services, compensation from AstraZeneca for consultant services, travel support from Boehringer Ingelheim, compensation from Boehringer Ingelheim for consultant services, compensation from Ipsen Pharma SAS for consultant services and compensation from Bristol-Myers Squibb for consultant services. Anna Cirkel: nothing to disclose. Tobias Wagner-Altendorf: nothing to disclose. Elena Rakusa: nothing to disclose. Michelle Oswald: nothing to disclose. Nils Werring: nothing to disclose. Ralf Ludwig: nothing to disclose. Jens Minnerup: nothing to disclose.
Royl et al. (Fri,) studied this question.