Hypersensitivity heparins

Other adverse reactions include local irritation when heparin is given via the SC route. Hypersensitivity reactions may also occur with any route of administration and include fever, chills, and urticaria. More serious hypersensitivity reactions include an astiima-like reaction and an anaphylactoid reaction. 

The LMWHs are contraindicated in patients witii a hypersensitivity to the drug, heparin, or pork products and inpatients with active bleeding or thrombocytopenia... 

It is also important that the nurse monitor for any indication of hypersensitivity reaction. The nurse reports reactions, such as chills, fever, or hives, to die primary health care provider. When heparin is given to prevent the formation of a thrombus, the nurse observes the patient for signs of thrombus formation every 2 to 4 hours. Because the signs and symptoms of dirombus formation vary and depend on the area or organ involved, die nurse should evaluate and report any complaint die patient may have or any change in die patient s condition to die primary health care provider. 

Hemorrhage is the main complication that can arise from heparin therapy. Other side effects include Heparin-Induced Thrombocytopenia Syndrome (HITS), local irritation, hypersensitivity reactions and with long-term use, alopecia, hypoaldoster-onism, and osteoporosis. 

Contraindications to heparin therapy include hypersensitivity to the drug, active bleeding, hemophilia, severe liver disease with elevated prothrombin time (PT), severe thrombocytopenia, malignant hypertension, and inability to meticulously supervise and monitor treatment. 

Hypersensitivity to LMWHs, heparin, or pork products hypersensitivity to sulfites or benzyl alcohol (multidose vials) history of heparin-induced thrombocytopenia (tinzaparin) active major bleeding thrombocytopenia associated with positive in... 

Hypersensitivity to heparin severe thrombocytopenia uncontrolled bleeding (except when it is due to DIG) any patient for whom suitable blood coagulation tests cannot be performed at the appropriate intervals (there is usually no need to monitor coagulation parameters in patients receiving low-dose heparin). 

Hypersensitivity reactions Heparin is derived from animal tissue use with caution in patients with a history of allergy. Before a therapeutic dose is given, a trial dose may be advisable. Have epinephrine 1 1000 immediately available. 

Contraindications Active major bleeding concurrent heparin therapy hypersensitivity to dalteparin, heparin, or pork products thrombocytopenia associated with positive in vitro test for antiplatelet antibody... 

The following patient categories were excluded from the study patients with ostial and bifurcation lesions, left ventricular ejection fraction <30%, known hypersensitivity or contraindication to aspirin or stainless steel, or a sensitivity to contrast dye, allergy to heparin or ticlopidine,... 

Antithrombin inhibits the activity of factors Ka, Xa, Xlla, and thrombin (Ila). It also inhibits thrombin-induced activation offactors V and VIII. UFH prevents the growth and propagation of a formed thrombus and allows the patient s own thrombolytic system to degrade the clot. Contrainchcations to heparin therapy include hypersensitivity to the drug, active bleeding, hemophilia, severe hver chsease with elevated prothrombin time (PT), severe thrombocytopenia, malignant hypertension, and inability to meticulously supervise and monitor treatment. 

Hypersensitivity reactions and skin necrosis (similar to that seen with warfarin) occur but are rare. Transient alopecia has been ascribed to heparin but in fact may be due to the severity of the thromboembolic disease for which the drug was given. 

Koch P, Munssinger T, Rupp-John C, Uhl K. Delayed-type hypersensitivity skin reactions caused by subcutaneous unfractionated and low-molecular-weight heparins tolerance of a new recombinant hirudin. J Am Acad Dermatol 2000 42(4) 612-19. 

Erythematous nodules or infiltrated and sometimes eczema-hke plaques at the site of injection are common adverse effects of subcutaneous standard heparin 3-21 days after starting heparin treatment. They are probably delayed-type hypersensitivity reactions and are also seen with low molecular weight heparin (65-69). There can be cross-reactivity between standard heparin and low molecular weight heparin (69). 

Moreau A, Dompmartin A, Esnault P, Michel M, Leroy D. Delayed hypersensitivity at the injection sites of a low-molecular-weight heparin. Contact Dermatitis 1996 34(1) 31. ... 

Dux S, Pitlik S, Perry G, Rosenfeld JB. Hypersensitivity reaction to chlorbutol-preserved heparin. Lancet 1981 1(8212) 149. 

Dux S, Pitlik S, Perry G, Rosenfeld JB. Hypersensitivity reaction to chlorobutanol-preserved heparin [letter]. Lancet 1981 i 149. Itabashi A, Katayama S, Yamaji T. Hypersensitivity to chlorobutanol in DDAVP solution [letter]. Lancet 1982 i 108. 

When used systemically, notably in a heparin injection preserved with chlorocresol 0.15%, delayed irritant and hypersensitivity reactions attributed to chlorocresol have been reported. " " See also Section 19. 

Active major bleeding, concurrent heparin therapy, thrombocytopenia associated with positive in vitro test for antiplatelet antibody, hypersensitivity to heparin or pork products Cautions Conditions with increased risk of hemorrhage, history of heparin-induced thrombocytopenia, impaired renal function, elderly uncontrolled arterial hypertension, history of recent GI ulceration and hemorrhage... 

IgE, or immunoglobulin E, is associated with mast cells, which are basophils, a type of granular white blood cell that has left the bloodstream and entered a tissue. Mast cells release histamine and heparin, chemicals that mediate allergic reactions. Not surprisingly, IgE is responsible for immediate hypersensitivity (allergic) reactions and immune defense against parasites. 

Toxicity Bleeding, osteoporosis, heparin-induced thrombocytopenia (HIT), hypersensitivity Bleeding, skin necrosis (if low protein C), drug interactions, teratogenic (bone dysmorphogenesis)... 

Danaparoid, a heparin of different structure, may be safer in hypersensitivity to heparin. 

Hirudin is a substance produced by medicinal leeches, which directly inactivates thrombin. Lepirudin is a synthetic version produced by recombinant DNA technology, which has to be given by injection. It is used specifically in patients that have developed hypersensitivity to heparin (see Chapter 3, page 35). 

Basophils are the least numerous and least well characterized of the circulating leukocytes. While they are not derived from the same progenitor cell as tissue mast cells, basophils and mast cells have several similar functions, including their participation in hypersensitivity reactions. Basophils have also been attributed roles in plasma lipolysis, parasite immunity, tumor cell cytotoxicity, and hemostasis. Increases have been associated with persistent lipemia, parasitism, allergic diseases, certain neoplastic diseases, and administration of certain drugs (e.g., heparin, penicillin). 

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