Low-molecular-weight heparin-induced skin necrosis

Füreder, Wolfgang; Kyrle, Paul A.; Gisslinger, Heinz; Lechner, Klaus

doi:10.1007/s002770050427

Cited by 11 publications

(6 citation statements)

References 23 publications

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“…Other thrombotic manifestations such as deep vein thrombosis, pulmonary embolism and adrenal infarction are also seen in patients with heparin-induced skin necrosis [4]. Highmolecular weight heparins and those of bovine lung sources may cause these complications more frequently than lower molecular weight heparins and those of porcine gut sources [1,5]. Skin necrosis may be seen at sites of heparin injection [2] or occur at distant sites such as thighs, abdomen and buttocks particularly in obese dia- betic women [6][7][8][9].…”

Section: Discussionmentioning

confidence: 99%

Heparin-Induced Skin Necrosis in a Patient with End-Stage Renal Failure and Functional Protein S Deficiency

2001

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Skin ulceration is a well-characterized thrombotic complication of the heparin-induced thrombocytopenia (HIT) syndrome. We present the case of a 73-year-old diabetic woman nearing end-stage renal failure who developed extensive upper thigh, abdominal and buttock ulceration following initiation of subcutaneous heparin for prophylaxis against deep vein thrombosis. A preliminary diagnosis of calciphylaxis was made based on the classical distribution and macroscopic appearance of the ulceration in a patient with end-stage renal failure and secondary hyperparathyroidism. However skin biopsy showed complete absence of calcium deposits in the dermal microvasculature. The presence of extensive microthrombi within dermal vessels prompted serologic testing to detect a prothrombotic state. We identified the combined presence of heparin-dependent platelet activating (HIT) antibodies and functional protein S deficiency. To our knowledge this is the first reported case of a dialysis patient presenting with skin ulceration induced by heparin and protein S deficiency. This case highlights the importance of a skin biopsy and testing for a hypercoaguable state in patients with end-stage renal disease and skin ulceration. We suggest that HIT antibodies should be requested in all dialysis patients presenting with skin ulceration.

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Section: Discussionmentioning

confidence: 99%

Heparin-Induced Skin Necrosis in a Patient with End-Stage Renal Failure and Functional Protein S Deficiency

2001

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“…Other rarer complications include allergic skin reactions, skin necrosis at the injection site, hyperkalaemia due to hypoaldosteronism, and alopecia [6,14,18,22].…”

Section: Adverse Effectsmentioning

confidence: 99%

Low molecular weight heparin in children

Albisetti

Andrew

2001

Eur J Pediatr

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“…There have been several reported cases of skin necrosis due to unfractionated heparin 7,8 and low molecular weight heparin 9,10 . This has also been reported for warfarin 11 .…”

Section: Discussionmentioning

confidence: 87%

Heparin‐induced skin necrosis

Khan¹,

Watson²

2000

BJOG

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A 57 year old, healthy woman with no previous illnesses was admitted in November 1998 for a vaginal hysterectomy and anterior repair for uterovaginal prolapse. She was not on any medication and she had no known drug allergies. She had never been given heparin or low molecular weight heparin in the past.On the morning of the operation she was given 5000 IU sodium heparin subcutaneously for thromboprophylaxis, and this was continued post-operatively 5000 IU in a dose twice daily. The vaginal hysterectomy and anterior repair were uneventful. The estimated blood loss was 300 mL. Her pre-operative platelet count was 220 x 109/L.Her post-operative course was complicated by mild anaemia, retention of urine and a urinary infection which were treated with ferrous sulphate, catheterization and trimethoporin. Because of her slow mobilisation of platelets the subcutaneous heparin was continued.On her eighth post-operative day it was noticed that she had massive areas of discolouration on both thighs where the heparin had been injected. On the left thigh the area measured 10 x 5 cm and was a dark red macular lesion, which was very tender. The lesion on the right thigh was similar and measured 5 x 3 cm. The heparin injections were stopped. Her platelet count was 249 x lo9& and her coagulation screen was normal. A thrombophilia screen was also normal. The heparin platelet factor 4 induced antibody test was 445% (normal range &305%). The area over the left thigh became necrotic. Both lesions gradually resolved over the next three months with symptomatic treatment. She was warned that she must never receive any form of heparin again. DiscussionHeparin-induced skin necrosis is a manifestation of the heparin-induced thrombocytopenia and thrombosis

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Low-molecular-weight heparin-induced skin necrosis

Cited by 11 publications

References 23 publications

Heparin-Induced Skin Necrosis in a Patient with End-Stage Renal Failure and Functional Protein S Deficiency

Heparin-Induced Skin Necrosis in a Patient with End-Stage Renal Failure and Functional Protein S Deficiency

Low molecular weight heparin in children

Heparin‐induced skin necrosis

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