Warfarin improves neuropathy in monoclonal gammopathy of undetermined significance.
We report a case of a 60-year-old man who was referred to a palliative care clinic with monoclonal gammopathy of undetermined significance (MGUS)-associated neuropathy, responding to a therapeutic trial of warfarin. Electromyography showed distal symmetric sensory axonal neuropathy. The patient reported having had improvement of his neuropathic symptoms while taking warfarin postoperatively for thromboprophylaxis 1 year prior, and recurrence of his symptoms after the warfarin was discontinued. The patient was rechallenged with a trial of warfarin, targeting an international normalised ratio of 1.5-2.0. His pain scores decreased from 5/10 to 3/10 at 1 month and symptom improvement was maintained through 24 months of follow-up. Warfarin had a remarkable impact on our patient's symptoms and quality of life. The mechanisms mediating the symptomatic benefit with warfarin are unclear; however, a placebo effect is unlikely. Further studies may help guide the use of warfarin for MGUS-associated neuropathy.
Division of Palliative Care, Greenville Health System, Greenville, South Carolina, USA.
Teny
T
Henry Gomez
Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University Health System, Richmond, Virginia, USA.
Beata
B
Holkova
Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University Health System, Richmond, Virginia, USA.
Danielle
D
Noreika
Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University Health System, Richmond, Virginia, USA.
Egidio
E
Del Fabbro
D000925:Anticoagulants / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000150:complications*; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy* / Q000209:etiology*; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin