Tolerance of fondaparinux in a patient allergic to heparins and other glycosaminoglycans

Ludwig, Ralf J.; Beier, Christian; Lindhoff-Last, Edelgard; Kaufmann, Roland; Boehncke, Wolf‐Henning

doi:10.1111/j.0105-1873.2003.0185a.x

Cited by 33 publications

(23 citation statements)

References 6 publications

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“…In addition, we identified female sex, obesity and long duration of heparin therapy as risk factors for cutaneous delayed-type hypersensitivity responses to heparin, which is consistent with previous reports. 2,4,5,16,17 We did not find age or pregnancy to be risk factors, 2 but few younger or pregnant patients were included in our study, limiting our ability to comment on these factors.…”

Section: Discussionmentioning

confidence: 86%

Incidence and causes of heparin-induced skin lesions

Schindewolf¹,

Schwaner²,

Wolter³

et al. 2009

Canadian Medical Association Journal

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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.

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Section: Discussionmentioning

confidence: 86%

Incidence and causes of heparin-induced skin lesions

Schindewolf¹,

Schwaner²,

Wolter³

et al. 2009

Canadian Medical Association Journal

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“…A few case reports described either formation of eczematous lesions at the injection site of a single dose of fondaparinux or tolerance. [4][5][6][7][8][9] When heparin intolerance occurs in pregnant patients with a high risk of thrombosis, choices of alternative anticoagulation are limited. Danaparoid has been used to treat pregnant women with heparin intolerance or a history of HIT.…”

Section: Introductionmentioning

confidence: 99%

Fondaparinux is a safe alternative in case of heparin intolerance during pregnancy

Mazzolai

Hohlfeld

Spertini

et al. 2006

Blood

103

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“…Nor does fondaparinux stimulate endotoxin-induced interleukin-8 production by monocytes [116]. The data also suggest that fondaparinux will be well tolerated by patients who have a tendency to develop delayed-type hypersensitivity reactions to subcutaneously injected heparin, probably because fondaparinux does not bind dermal proteins [117,118]. Clearly, careful selection of a heparin structure for activity against a target protein, in this case antithrombin III, does eliminate many of the undesirable effects of heparin therapy.…”

Section: Towards the Use Of Heparin Or Heparan Structures As Therapeumentioning

confidence: 99%

Heparan sulfate-protein interactions: therapeutic potential through structure-function insights

Coombe

Kett²

2005

CMLS, Cell. Mol. Life Sci.

119

101

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Heparin and the related glycosaminoglycan, heparan sulfate, bind a myriad of proteins. The structural diversity of heparin and heparan sulfates is enormous, but differences in the conformational flexibility of the monosaccharide constituents add extra complexity and may influence protein binding. Silencing genes for heparin/ heparan sulfate biosynthetic enzymes profoundly affects mammalian development. Thus, altering the structure of heparan sulfate chains can alter protein binding and embryo development. Different heparan sulfate structures are located in particular tissue sites, and these structures are recognised by different sets of proteins. Regulation of certain heparan sulfate-protein interactions by pH or cations is described. Heparin/heparan sulfate structures are viewed as potential therapeutics for a variety of diseases. An understanding at the molecular and functional levels of the specificity and affinity of heparan sulfate-protein interactions is crucial for designing heparin-inspired drugs. How the development of synthesis techniques is facilitating structure-function analyses and drug development is discussed.

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Tolerance of fondaparinux in a patient allergic to heparins and other glycosaminoglycans

Cited by 33 publications

References 6 publications

Incidence and causes of heparin-induced skin lesions

Incidence and causes of heparin-induced skin lesions

Fondaparinux is a safe alternative in case of heparin intolerance during pregnancy

Heparan sulfate-protein interactions: therapeutic potential through structure-function insights

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