Enoxaparin-induced alopecia in patients with cerebral venous thrombosis

Abstract

From the review of literature, there is no report of alopecia caused by urokinase. Using the Naranjo ADR Probability Scale, a score of 6 suggests that enoxaparin was the probable cause of alopecia in our three patients. This report introduces evidence of alopecia as a probable side effect of enoxaparin, but stresses the efficacy and safety of LMWH. As this is not a life-threatening disorder, we hope to increase the awareness of pharmacists and clinicians to this relatively rare but important side effect.

Pharmacology of Heparin and Related Drugs

“…The occurrence of alopecia has been known as a side effect of long-term UH therapy for some time (Hirschboeck et al, 1954). LMWHs have also been noted to cause alopecia (Barnes et al, 2000;Sarris et al, 2003;Wang and Po, 2006); however, the frequency of this reaction, as with UH, is considered very low, although the occurrence has not been precisely defined. The mechanism involved is unclear, and there are suggestions that heparin influences the growth cycle of epithelial cells (Paus, 1991) and may interfere with heparanase, which also possesses a role in hair growth (Zcharia et al, 2005).…”

Case studies in anticoagulation management

“…For patients like MD, elevated and unstable INR results and challenging warfarin dosing are expected with antiphospholipid syndrome patients [51][52][53][54][55][56][57][58][59][60]. Case reports and one clinical trial have used oral vitamin K doses ranging from 80-500 lg/day [46][47][48][49][50]61]. The optimal oral vitamin K daily dose has yet to be established.…”

“…Weekly INR monitoring for 2 years is unusual and labor-intensive, even for labile INR patients. Using oral daily vitamin K is one strategy, although not currently supported by the literature for routine use [46][47][48][49][50]. Before considering vitamin K, it is good practice to rule out other causes of labile INRs such as alcohol binges, variable doses of acetaminophen or related products, new infections with fever and/or antibiotics, diarrhea, warfarin compliance (extra, missed or wrong doses), and warfarin self-dosing.…”

“…After 2 years of labile INRs, the anticoagulation clinic staff tried to stabilize MD's INRs with small daily doses of oral vitamin K, based upon published reports [46][47][48][49]. By April 2006, she agreed to take two soft calcium chewable tablets daily, each containing 40 lg of vitamin K per tablet.…”

Alopecias

“…After 3 weeks of treatment with enoxaparin, therapy was switched to warfarin. In all three cases, hair growth returned to normal within 4 weeks after enoxaparin was discontinued [ 34 ]. Interestingly, Sarris and colleagues reported the case of a 66-year-old patient who developed diffuse alopecia attributed to tinzaparin that resolved with enoxaparin was substituted [ 35 ].…”