Association of heparin‐induced skin lesions, intracutaneous tests, and heparin‐induced IgG

Harenberg, Job; Huhle, G.; Wang, L; Hoffmann, Ursula; Bayerl, C.; Kerowgan, M.

doi:10.1034/j.1398-9995.1999.00048.x

Cited by 52 publications

(52 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…11 In addition, data from a recently initiated trial investigating the incidence and nature of skin lesions in patients with suspected and confirmed immune heparininduced thrombocytopenia further support our conclusions. We have so far not observed any heparin-associated skin lesions in this cohort of patients (including 11 with immune heparin-induced thrombocytopenia).…”

Section: 21supporting

confidence: 72%

“…[2][3][4] Heparininduced skin lesions may be caused by at least 5 mechanisms: delayed-type (type IV) hypersensitivity responses, 2,[4][5][6] immune-mediated thrombocytopenia, 3 type I allergic reactions, 7,8 skin necrosis 9 and pustulosis. 10 Heparin-induced skin lesions may indicate the presence of life-threatening heparin-induced thrombocytopenia 11 -even in the absence of thrombocytopenia. 3 There are no data available on the incidence of heparin-induced skin lesions or their causes.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Incidence and causes of heparin-induced skin lesions

Schindewolf¹,

Schwaner²,

Wolter³

et al. 2009

Canadian Medical Association Journal

View full text Add to dashboard Cite

Background: Little is known about the incidence and causes of heparin-induced skin lesions. The 2 most commonly reported causes of heparin-induced skin lesions are immune-mediated heparin-induced thrombocytopenia and delayed-type hypersensitivity reactions. Methods:We prospectively examined consecutive patients who received subcutaneous heparin (most often enoxaparin or nadroparin) for the presence of heparin-induced skin lesions. If such lesions were identified, we perfor med a skin biopsy, platelet count measurements, and antiplatelet-factor 4 antibody and allergy testing. Results:We enrolled 320 patients. In total, 24 patients (7.5%, 95% confidence interval [CI] 4.7%-10.6%) had heparin-induced skin lesions. Delayed-type hypersensitivity reactions were identified as the cause in all 24 patients. One patient with histopathologic evidence of delayedtype hypersensitivity tested positive for antiplatelet-factor 4 antibodies. We identified the following risk factors for heparin-induced skin lesions: a body mass index greater than 25 (odds ratio [OR] 4.6, 95% CI 1.7-15.3), duration of heparin therapy longer than 9 days (OR 5.9, 95% CI 1.9-26.3) and female sex (OR 3.0, 95% CI 1.1-8.8).Interpretation: Heparin-induced skin lesions are relatively common, have identifiable risk factors and are commonly caused by a delayed-type hypersensitivity reaction (type IV allergic response). (ClinicalTrials.gov trial register no.

show abstract

Section: 21supporting

confidence: 72%

mentioning

confidence: 99%

Incidence and causes of heparin-induced skin lesions

Schindewolf¹,

Schwaner²,

Wolter³

et al. 2009

Canadian Medical Association Journal

View full text Add to dashboard Cite

show abstract

“…By way of intracutaneous testing, heparin-induced platelet activation and the presence of circulating heparin-induced IgG, cross-sensitivity to low molecular weight heparin and heparinoid has been found in 50% of heparin-allergic patients [2,3]. Thus in a case of heparin allergy, therapeutic options are limited.…”

Section: Discussionmentioning

confidence: 99%

Management of heparin allergy in pregnancy

2001

View full text Add to dashboard Cite

Thromboembolic disease during pregnancy has traditionally been treated with heparin. If heparin cannot be used, then treatment options remain limited. Despite the recent availability of new anticoagulation agents, data relating to their use during pregnancy is lacking. Hirudin, a relatively new anti-thrombotic agent, through animal models has been shown to have a very low transplacental transfer, thus making it a candidate drug to be used during pregnancy in case of heparin allergy. This report describes a case of heparin allergy in a pregnant patient with recurrent DVT that was successfully managed with hirudin and coumadin. Am. J. Hematol. 67:268-269, 2001.

show abstract

“…1,4,12 More recently, non-necrotizing skin lesions associated with lowmolecular weight heparin injections were described to be only weakly associated with HIT or anti-platelet/heparin factor 4 antibodies and were classified as a delayed-type hypersensitivity reaction. 12 However, in this case, these skin lesions clearly heralded the onset of HIT.…”

Section: Discussionmentioning

confidence: 99%

“…3 Skin lesions at heparin injection sites occur in 10-20% of patients with HIT and may precede thrombocytopenia. 4 We report herein a case of HIT associated with a fatal anaphylactoid reaction to UFH that was preceded by therapy with enoxaparin sodium and was heralded by a non-necrotizing erythematous rash at heparin injection sites.…”

Section: Introductionmentioning

confidence: 99%

Fatal anaphylactoid reaction associated with heparin-induced thrombocytopenia

et al. 2013

View full text Add to dashboard Cite

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.

show abstract

Association of heparin‐induced skin lesions, intracutaneous tests, and heparin‐induced IgG

Abstract: On the basis of the coincidence of local and systemic hyperreactivity to heparin and danaparoid, patients with heparin-induced skin lesions should receive r-hirudin, a nonheparin compound, for anticoagulant treatment.

Cited by 52 publications

References 7 publications

Incidence and causes of heparin-induced skin lesions

Incidence and causes of heparin-induced skin lesions

Management of heparin allergy in pregnancy

Fatal anaphylactoid reaction associated with heparin-induced thrombocytopenia

Contact Info

Product

Resources

About