Heparin-induced haemorrhagic bullous dermatosis

Snow, Sarah; Pearson, David R.; Fathi, Ramin; Alkousakis, Theodore; Winslow, Caroline Y.; Golitz, Loren E.

doi:10.1111/ced.13327

Cited by 20 publications

(34 citation statements)

References 18 publications

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“…BHD is sometimes associated with eczematous reaction at sight of injection that may suggest a type IV hypersensitivity reaction [ 32 ]. The propensity for developing lesions on the extremities in older patients also posits local trauma combined with epidermal-dermal fragility as an underlying mechanism [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Bullous hemorrhagic dermatosis is an under-recognized side effect of full dose low-molecular weight heparin: a case report and review of the literature

et al. 2018

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Bullous hemorrhagic dermatosis (BHD) is a systemic side-effect of low molecular weight heparin, characterized by multiple intra-epidermal hemorrhages distant from the site of injection. There have been several small case series and literature reviews on BHD, but none have captured a complete set of reported patients. We sought to describe a case of BHD with late diagnosis and completely summarize the existing English and Spanish literature with searches of Pubmed, Scopus, Ovid Embase and Ovid Medline. After narrowing to 33 relevant reports, we describe 90 reported cases worldwide from 2004 to 2017, in addition to a new case from our institution as a means of comparison. We found that BHD was common in elderly men (mean age 72 ± 12; male:female, 1.9:1) and typically occurred within 7 days of administration of anticoagulation (median 7 days ± 6.4) usually with enoxaparin use (66% of cases). Lesions occurred primarily on the extremities only (67.9% of cases). Coagulation testing was most often normal before administration, and the majority of patients had coagulation testing in therapeutic range during treatment. Most practitioners stopped anticoagulation if continued therapeutic intervention was no longer required (57% of cases), or changed therapy to another anticoagulation if continued treatment was required (14.3% of cases). Therapy was continued outright in 23% of patients. The lesions usually resolved within 2 weeks (mean days, 13.0 ± 7.4). There was no difference in time to resolution between patients who continued the culprit anticoagulant or changed to a different anticoagulant, and those who discontinued anticoagulation altogether (13.9 days vs. 12.1, p = 0.49). Four deaths have been reported in this clinical context, two specified as intracranial hemorrhage. These deaths were unrelated to the occurrence of BHD. Continuation of low-molecular weight heparins appeared to be safe in patients with BHD.

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Section: Discussionmentioning

confidence: 99%

Bullous hemorrhagic dermatosis is an under-recognized side effect of full dose low-molecular weight heparin: a case report and review of the literature

et al. 2018

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“…Skin lesions may resolve even if anticoagulation therapy is continued at the same dose. 7,8 Concurrent supportive wound care is beneficial.…”

Section: Photo Challenge Discussionmentioning

confidence: 99%

Hemorrhagic Papular Eruption on the Dorsal Hands

Brown

Jing

Siddiqui

et al. 2020

Cutis

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A 66-year-old woman with a history of granulomatous lung disease managed with methotrexate and prednisone, diabetes mellitus, hypertension, and Grave disease was admitted to the hospital for hypoxic respiratory failure. At admission, treatment was empirically initiated for pneumonia with intravenous ceftriaxone and azithromycin. Given the concern of a pulmonary embolism, intravenous heparin also was initiated. Dermatology was consulted for multiple painless blood blisters that erupted on the hands within 24 hours of admission. Physical examination revealed numerous firm hemorrhagic papules on the dorsal hands. Laboratory workup revealed a slightly elevated white blood cell count (11,800/µL [reference range, 4500-11,000/µL]), a normal stable platelet count (231,000/µL [reference range, 150,000-350,000/µL]), and a normal international normalized ratio. WHAT'S YOUR DIAGNOSIS? a. bullous drug eruption b. disseminated herpes zoster c. heparin-induced bullous hemorrhagic dermatosis d. heparin necrosis e. leukocytoclastic vasculitis

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“…1,2 Bullous hemorrhagic dermatosis is likely underreported, and only 97 cases have been described in peerreviewed journals. 1,[3][4][5][6] The condition has been reported previ-ously in relation to a combination of fonda parinux and warfarin. 7,8 There have been no reported cases associated with direct oral anticoagulants.…”

Section: Probable Fondaparinux-associated Bullous Hemorrhagic Dermatosismentioning

confidence: 99%

“…In a summary of 91 reported cases of bullous hemorrhagic dermatosis, Russo and colleagues found that lesions are not typically painful, pruritic or associated with other systemic symptoms; and lesion distribution is most often distant to injection sites, with primary sites affected being the extremities, followed by the torso, with rare involvement of the mucosal membranes. 1,4 In most cases, bullous hemorrhagic dermatosis is self-resolving, with time to resolution within an average of 13 days. 9 Four deaths have been associated with the condition.…”

Section: Probable Fondaparinux-associated Bullous Hemorrhagic Dermatosismentioning

confidence: 99%

Probable fondaparinux-associated bullous hemorrhagic dermatosis

Lovatt

Yousuf

2021

CMAJ

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Heparin-induced haemorrhagic bullous dermatosis

Abstract: The typical clinical course is spontaneous resolution within days to weeks irrespective of continuation of heparin therapy. Because of its self-limiting nature, interruption of heparin therapy may not be required.

Cited by 20 publications

References 18 publications

Bullous hemorrhagic dermatosis is an under-recognized side effect of full dose low-molecular weight heparin: a case report and review of the literature

Bullous hemorrhagic dermatosis is an under-recognized side effect of full dose low-molecular weight heparin: a case report and review of the literature

Hemorrhagic Papular Eruption on the Dorsal Hands

Probable fondaparinux-associated bullous hemorrhagic dermatosis

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