Enoxaparin-Induced Skin Necrosis: A Fatal Outcome

Singh, Sarabjeet; Verma, Meenakshi; Bahekar, Amol; Agrawal, Pawan K.; Duggal, Jasleen; Iliescu, Maria Elena; Khosla, Pam; Muzaffar, Shirin

doi:10.1097/mjt.0b013e3180325905

Cited by 12 publications

(8 citation statements)

References 8 publications

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“…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] .…”

Section: Introductionsupporting

confidence: 52%

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

et al. 2018

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Enoxaparin is a widely used low-molecular-weight heparin for perioperative thromboembolic prophylaxis. Enoxaparin-induced skin necrosis in the setting of arthroplasty has been rarely reported in the literature with varying outcomes and management decisions. Our patient developed skin necrosis at his injection site and thrombocytopenia 10 days following left total knee arthroplasty surgery and after receiving subcutaneous Lovenox injections postoperatively. The patient was started on an alternative anticoagulation based on a high suspicion for heparin-induced thrombocytopenia and the wound was monitored without surgical debridement. Our case highlights the key clinical management decisions when facing this potentially life-threatening adverse reaction.

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Section: Introductionsupporting

confidence: 52%

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

et al. 2018

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“…According to the published reports the patients who developed this type of condition were treated successfully with local excision [6]- [9]. In one single previous report the outcome was fatal [10]. In our patient the necrotic tissue was the source of sepsis and ultimately with the fatal consequence.…”

Section: Discussionmentioning

confidence: 69%

Abdominal Skin Necrosis after Enoxaparin Treatment

Maruan¹,

Nierenberg²,

Falah³

et al. 2014

OJCD

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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.

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“…Unlike our study, results from a nested case–control study conducted on AF patients using the UK Clinical Practice Research Datalink supported this theory, since Azoulay et al found a 71% increased risk of stroke in the first 30 days of warfarin use compared with nonuse, whereas a decreased risk was observed after 30 days of use 45. However, this theory does not justify the routine use of bridging therapy since VKA‐induced skin necrosis occurs mostly in patients with inherited or acquired thrombophilia, such as protein C or S deficiencies,44 and several case studies have also reported that LMWH can also lead to skin necrosis 46, 47. Lastly, there is insufficient evidence justifying systematic use of bridging therapy.…”

Section: Discussionmentioning

confidence: 99%

Short‐Term Risk of Bleeding During Heparin Bridging at Initiation of Vitamin K Antagonist Therapy in More Than 90 000 Patients With Nonvalvular Atrial Fibrillation Managed in Outpatient Care

Bouillon¹,

Bertrand²,

Boudali³

et al. 2016

JAHA

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BackgroundSeveral studies have recently examined the risks of bleeding and of ischemic stroke and systemic embolism associated with perioperative heparin bridging anticoagulation in patients with nonvalvular atrial fibrillation. However, few studies have investigated bridging risks during vitamin K antagonist initiation in outpatient settings.Methods and ResultsA retrospective cohort study was conducted on individuals starting oral anticoagulation between January 2010 and November 2014 for nonvalvular atrial fibrillation managed in outpatient care and identified from French healthcare insurance. Bleeding and ischemic stroke and systemic embolism events were identified from the hospitalization database. Adjusted hazard ratios with 95% CI were estimated using Cox models during the first and 2 following months of anticoagulation. Of 90 826 individuals, 30% had bridging therapy. A total of 318 (0.35%) cases of bleeding and 151 (0.17%) ischemic stroke and systemic embolism cases were identified during the first month of follow‐up and 231 (0.31%) and 122 (0.16%) during the 2 following months, respectively. At 1 month of follow‐up, the incidence of bleeding was higher in the bridged group compared with the nonbridged group (0.47% versus 0.30%; P<0.001), and this increased risk persisted after adjustment for covariates (hazard ratio=1.60; 95% CI, 1.28–2.01). This difference disappeared after the first month of treatment (0.93; 0.70–1.23). No significant difference in the occurrence of ischemic stroke and systemic embolism was observed either at 1 month of follow‐up or later.ConclusionsAt vitamin K antagonist initiation for nonvalvular atrial fibrillation managed in ambulatory settings, bridging therapy is associated with a higher risk of bleeding and a similar risk of arterial thromboembolism compared with no bridging therapy.

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Enoxaparin-Induced Skin Necrosis: A Fatal Outcome

Cited by 12 publications

References 8 publications

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

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

Abdominal Skin Necrosis after Enoxaparin Treatment

Short‐Term Risk of Bleeding During Heparin Bridging at Initiation of Vitamin K Antagonist Therapy in More Than 90 000 Patients With Nonvalvular Atrial Fibrillation Managed in Outpatient Care

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