Acute cardiorespiratory collapse from heparin: a consequence of heparin‐induced thrombocytopenia

Mims, Martha P.; Manian, Prasad; Rice, Lawrence

doi:10.1111/j.1600-0609.2004.00224.x

Cited by 36 publications

(17 citation statements)

References 17 publications

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“…6,7 Such anaphylactoid reactions have been linked to HIT. 8 Current guidelines recommend prompt measurement of the platelet count as thrombocytopenia may be abrupt, severe, and transient. 3 Prior reports indicate that IgG as well as IgE can mediate immediate hypersensitivity reactions to protamine, lepirudin and thiamine by activating the complement pathway leading to generation of anaphylatoxins (C3a, C4a and C5a).…”

Section: Discussionmentioning

confidence: 99%

Fatal anaphylactoid reaction associated with heparin-induced thrombocytopenia

et al. 2013

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Acute systemic (anaphylaxis and anaphylactoid) reactions have been well described in patients with heparin-induced thrombocytopenia (HIT). Both necrotizing and non-necrotizing skin lesions at heparin injection sites have been reported and may occur in 10-20% of patients with HIT. We report herein a patient treated with subcutaneous enoxaparin sodium who developed non-necrotizing erythematous skin lesions at enoxaparin sodium injection sites. A subsequent intravenous bolus of unfractionated heparin produced a fatal anaphylactoid reaction. This suggests that caution should be exercised in the administration of intravenous heparin to patients with non-necrotizing erythematous skin lesions at prior heparin injection sites.

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Section: Discussionmentioning

confidence: 99%

Fatal anaphylactoid reaction associated with heparin-induced thrombocytopenia

et al. 2013

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“…Anaphylactoid reactions are a known feature of rapidonset HIT [11][12][13]. Table II lists the various signs and symptoms that have been reported [11][12][13].…”

Section: Commentarymentioning

confidence: 99%

“…Table II lists the various signs and symptoms that have been reported [11][12][13]. Most often, these reactions occur 5-30 min (median, 10 min) after intravenous bolus heparin administration.…”

Section: Commentarymentioning

confidence: 99%

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Chills and limb pain following administration of low‐molecular‐weight heparin for treatment of acute venous thromboembolism

et al. 2011

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“…The patient's recent heparin exposure resulted in formation of HIT antibodies such that repeat exposure to heparin via an IV bolus precipitated "rapid-onset" HIT. A repeat platelet count would have shown an abrupt platelet count fall [20,21]. HIT-associated anaphylactoid reactions occur 10 min (median) post-UFH bolus (the exact timing in our patient), and patients are typically described as hypertensive (not hypotensive as in PE), hypoxemic, dyspneic, and may have chest pain.…”

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confidence: 99%

Non–injection‐site necrotic skin lesions complicating postoperative heparin thromboprophylaxis

Tassava

Warkentin

2015

American J Hematol

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A 75-year-old African-American man with Type II diabetes, hypertension, and hyperlipidemia was admitted with a painful right leg secondary to bilateral iliac artery obstruction. Admission hemoglobin level was 14.4 g/dL, white blood count was 11.9 3 10 9 /L (neutrophils, 10.4 3 10 9 /L), and the platelet count was 366 3 10 9 /L. Unfractionated heparin 5,000 IU thrice daily by subcutaneous injection was given for 5 days. Aortobifemoral bypass surgery was performed with full-dose intravenous heparin followed by daily subcutaneous unfractionated heparin thromboprophylaxis. After an initial decline, the platelet count rose to 480 3 10 9 /L on postoperative Day 4 (Day 10 after start of preoperative course of heparin), at which time the patient developed a swollen right leg. Vascular duplex revealed a gastrocnemius vein clot of indeterminate age, which was not treated.This patient was found to have a gastrocnemius vein thrombosis on Day 4 after surgery. Controversy exists over whether to anticoagulate deep muscular vein thromboses. No large randomized trials have been done, and some smaller studies show similar resolution with or without anticoagulation [1,2]. Thus, the decision to continue subcutaneous (SC) prophylactic-dose heparin was reasonable.On postoperative Day 5, a right leg patchy retiform purpuric skin rash developed (Fig. 1A). Arterial duplex showed improved but still poor arterial flow to the right leg. Skin biopsy (right medial thigh) showed intravascular thrombus in a mid-dermal vessel and partial epidermal necrosis, without vasculitis (Fig. 1B,C). Laboratory investigations, including complete blood count, measurement of antithrombin, protein C, protein S, ANCA, cryoglobulins, homocysteine, viral hepatitis serology, complement, and antiphospholipid antibodies, were normal/ negative. The necrotic skin rash was considered secondary to "transient ischemia" during the preceding vascular surgery. The patient was discharged to a rehabilitation facility off heparin.The patient's right lower limb rash included multiple discrete lesions extending from the thigh to the ankle with blisters, SC hemorrhage, and necrosis in an angulated branched configuration described as "retiform purpura." These lesions have a broad differential, including vasculitis, hypercoagulable state, purpura fulminans, cholesterol embolism, thrombotic thrombocytopenic purpura, disseminated intravascular coagulation, warfarin-induced skin necrosis, heparin-induced skin necrosis, cryoglobulinemia, and calciphylaxis [3][4][5]. The biopsy finding of epidermal necrosis and intravascular thrombus without vasculitis, calcification, or inflammatory cell infiltrate, plus the negative hypercoagulability testing, lack of infection, renal failure, hemolysis, and absence of warfarin therapy, rules out most of these entities. Additionally, skin necrosis from low blood flow alone can be seen in livedo racemosa, but this entity is accompanied by a perilesional violaceous reticulated skin discoloration, which was not seen [3,4].Our patient had received SC inj...

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Acute cardiorespiratory collapse from heparin: a consequence of heparin‐induced thrombocytopenia

Cited by 36 publications

References 17 publications

Fatal anaphylactoid reaction associated with heparin-induced thrombocytopenia

Fatal anaphylactoid reaction associated with heparin-induced thrombocytopenia

Chills and limb pain following administration of low‐molecular‐weight heparin for treatment of acute venous thromboembolism

Non–injection‐site necrotic skin lesions complicating postoperative heparin thromboprophylaxis

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