Successful Administration of Low Molecular Weight Heparin in a Patient with Heparin-lnduced Thrombocytopenia and Coumarin-lnduced Skin Necrosis

Abstract

A case of heparin-induced thrombocytopenia and skin necrosis induced by coumarin is reported in a 58-year-old female patient suffering from metastatic breast adenocarcinoma and deep vein thrombosis. The thrombosis resolved after treatment with low molecular weight heparin and the thrombocytopenia recovered within a few days. The occurrence of both these rare complications in the same patient has not been previously reported in the literature. We present a review of these complications and their current treatment.

Late‐onset warfarin‐induced skin necrosis: case report and review of the literature

“…In addition to the present case, LMW heparin has previously been used successfully for the treatment of venous thrombosis in other patients with warfarin-induced skin necrosis [9,23]. While osteoporosis is a common side effect of chronic administration with standard heparin, recent studies have demonstrated that LMW heparin at therapeutic levels results in less calcium release from bone [24] and less fractures [25].…”

Heparin‐induced thrombocytopenia and fatal thrombosis in a patient with activated protein C resistance

“…The treatment of HIT includes discontinuation of heparin and institution of alternative antithrombotic therapy. It has recently been shown that LMW heparin may be beneficial in some patients with HIT [15]. However, the patient described here did not benefit from such therapy, and Enoxaparin was discontinued due to sustained severe thrombocytopenia.…”

Multicentric warfarin-induced skin necrosis complicating heparin-induced thrombocytopenia

“…Only a few reports have described a possible association between WISN and HIT [22][23][24][25][26]. However, most of these reports [22][23][24][25] either did not perform diagnostic laboratory testing for HIT antibodies, or described patients who had other underlying disorders, such as adenocarcinoma [27] or congenital protein C deficiency [5][6][7], that are known to predispose to warfarin-induced prothrombotic complications. There have also appeared reports of apparent WISN, in which unexplained thrombocytopenia that began during heparin therapy was noted by the authors [6,28,29].…”