Skin lesions heparins

Heparin is associated with an increased risk of bleeding either due to over anticoagulation or the occurrence of heparin inducted thrombocytopenia. The risk of major bleeding associated with heparin is reported to be 0% to 7% (7,8). The long-term administration of UFH may also be associated with osteopenia, Other reported adverse effects include skin lesions, priaprism, and elevated liver enzymes,... 

Bircher AJ, Itin PH, Buchner SA. Skin lesions, hyper-eosinophilia, and subcutaneous heparin. Lancet 1994 343(8901) 861. 

Koch P, Hindi S, Landwehr D. Delayed allergic skin reactions due to subcutaneous heparin-calcium, enoxaparin-sodium, pentosan polysulfate and acute skin lesions from systemic sodium-heparin. Contact Dermatitis 199634(2) 156-8. 

Warkentin TE. Heparin-induced skin lesions. Br J Haematol 1996 92(2) 494-7. 

Two forms of heparin-induced thrombocytopenia (HIT) have been observed. The first (HIT I) is a transient, mild, and benign thrombocytopenia seen soon after initiation of heparin therapy (normally within 2 days) and is felt to be due to inherent plateletaggregating properties of heparin. A second, more severe form of HIT (HIT II) is typically seen later and is immune-mediated. The incidence of HIT II is estimated at 3-5%. The onset is generally 3-14 days after initiation of heparin therapy but may occur sooner with repeat exposure. HIT II may occur with any dose and type of heparin, but the frequency is highest with continuous intravenous infusions of unfractionated heparin. HIT with subsequent thrombosis is a feared complication. These thrombi can form in the venous or arterial circulation. Thrombotic complications include necrotic skin lesions, myocardial infarction, stroke, and gangrene. Hyperkalemia may be seen with heparin therapy due to aldosterone synthesis inhibition. 

A large percentage of patients develop asymptomatic VTE. PE occurs in 25% of patients with thrombotic complications and contributes significantly to mortality. Arterial thrombosis occurs less commonly. Limb artery occlusion, stroke, and myocardial infarction are the most commonly reported arterial events. Heparin-induced skin lesions occur in 10% to 20% of patients with HIT. Lesions range from painful, localized erythematous plaques to widespread dermal necrosis. Amputation in such cases frequently is required. Mortality from HIT may be as high as 36% in patients with acute thrombosis. The relatively high frequency of thrombotic complications and poor outcomes... 

Heparin-induced thrombocytopenia (platelet count <150,000/ml or a 50% decrease from the pretreatment value) occurs in about 0.5% of medical patients 5 to 10 days after initiation of therapy with standard heparin. The incidence of thrombocytopenia is lower with low-molecular-weight heparin. Thrombotic complications that can be life threatening or lead to amputation occur in about one-half of the affected heparin-treated patients and may precede the onset of thrombocytopenia. The incidence of heparin-induced thrombocytopenia and thrombosis is higher in surgical patients. Venous thromboembolism occurs most commonly, but arterial thromboses causing limb ischemia, myocardial infarction, and stroke also occur. Bilateral adrenal hemorrhage, skin lesions at the site of subcutaneous heparin injection, and a variety of systemic reactions may accompany heparin-induced thrombocytopenia. The development of IgG antibodies against complexes of heparin with... 

Schindewolf M, Kroll H, Ackermann H, Garbaraviciene J, Kaufmaim R, Boehneke W-H, Ludwig RJ, Lindhoff-Last E. Heparin induced nonnecrotizing skin lesions rarely associated with heparin-induced thrombocytopenia. J Thromb Haemost 2010 8 1486-91. 

Skin Of 320 patients, 24 (7.5% 95% Cl = 4.7, 11) had heparin-induced skin lesions, which were delayed-type hypersensitivity reactions in all cases [110 ]. The... 

Immunologic A patient with delayed-type hypersensitivity to heparins was given danaparoid subcutaneously for thrombosis prophylaxis after orthopedic surgery and after the first few injections developed eczematous plaques followed by generalized eczema despite treatment with topical and oral glucocorticoids danaparoid was replaced by intravenous heparin, and there was rapid resolution of the skin lesions [130 ]. 

Boehneke WH, Lindhoff-Last E, Ludwig RJ. Incidence and causes of heparin-induced skin lesions. CMAJ 2009 181 (8) 477-81. 

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