Abdominal Skin Necrosis after Enoxaparin Treatment

Abstract

Subcutaneous low molecular weight heparin (LMWH) injection is a prophylactic treatment for deep vein thrombosis after surgery in lower limb before the patient is fully ambulated. This treatment is usually safe. One of the major and rare complications of the LMWH injection is thrombocytopenia, which is usually self-limiting. We present a rare case of patient with thrombocytopenia, induced by subcutaneous injection of LMWH (enoxaparin) that was complicated with a large hematoma at the injection site with subsequential skin necrosis, sepsis with fatal outcome. We would like to emphasize this rare complication of the common prophylactic treatment by LMWH in order to pursue this diagnosis when similar cutaneous manifestation might appear in patients who receive prophylactic treatment with LMWH.

Enoxaparin-induced skin necrosis at injection site after total knee arthroplasty

“…Along with bleeding risk, rare cutaneous side effects have been reported in the literature [2] , [3] . Enoxaparin-induced skin necrosis, as seen in our case, has been associated with grave consequences, including death [4] , [5] .…”

“…We are aware of 3 prior case reports in the literature documenting Lovenox-induced skin necrosis in the setting of TKA. In the case by Maruan et al [5] , thrombocytopenia was found on POD 4, followed by skin necrosis developing on POD 5. The LMWH was discontinued but there was no mention of starting aspirin or a direct thrombin inhibitor.…”

Rare presentation of enoxaparin-induced skin necrosis in a postoperative patient

“…Although rare, enoxaparin-induced skin necrosis is a very serious complication, with reported fatalities due to development of sepsis 7 8. Additionally, a fatality was reported where a patient developed thrombocytopenia, leading to a large abdominal haematoma, with subsequent development of necrosis and septic shock 9…”