Adverse Drug Reactions and Cutaneous Manifestations Associated With Anticoagulation

Abstract

Anticoagulants are amongst the most commonly prescribed medications worldwide. Although rare, localised and systemic drug reactions have been reported with anticoagulants that can lead to significant morbidity and mortality. Some of the first signs of drug reactions to anticoagulants are cutaneous changes that, when recognised early, can prevent significant complications. Dermatologists should be aware of these changes to make an early and accurate diagnosis. This is particularly important in instances of skin-induced necrosis caused by systemic toxicity to anticoagulants. This review discusses adverse drug reactions to the traditional anticoagulants, warfarin and heparin, and the newer direct oral anticoagulants (DOACs) such as the thrombin inhibitor, dabigatran, and the factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban. In particular, this review provides dermatologists with a framework for early diagnosis and management of patients with drug reactions to anticoagulants and alerts them to potential bleeding complications associated with minor procedures.

A rare case report of apixaban-induced lichenoid eruption

“…12,13 Hypersensitivity drug reactions associated with anticoagulants are being increasingly reported in the literature. 14 Symmetric eruption of violaceous papules on the trunk and extremities with possible lacelike patterns are highly characteristic of drug-induced lichen planus resembling our patient case and is a relatively uncommon cutaneous drug reaction. The time to onset of this type of drug reaction is reported as ranging from a few months to a year or more depending on the offending drug type.…”

Breast necrosis in a chronic user of warfarin

“…Skin necrosis is a rare condition, with incidence of 0.1 to 0.01% of cases in users of oral anticoagulant therapy whose action mechanism is the antagonism of vitamin K [1][2][3][4][5][6][7][8][9] . Flood et al described the condition for the first time in 1943 10 , but a causal relation between tissue necrosis and use of oral anticoagulants was only established in the late 1950s 11 .…”

Drug reaction with eosinophilia and systemic symptoms syndrome induced by apixaban

“…2 However, few case reports have documented cutaneous reactions with edoxaban, there are also rivaroxaban induced exanthematous drug eruptions, urticaria, angioedema and DRESS reported in the literature. 6 Diagnosis of DRESS syndrome is a challenging; it is mandatory to rule out other "mimickers" such as infections, hematological disorders, connective tissue diseases, and other severe adverse drug reactions. 7 Withdrawal of the suspected drug is the first step in the treatment; systemic steroids are usually recommended.…”