Heparin-induced skin lesions

Schindewolf, Marc; Lindhoff-Last, Edelgard; Ludwig, Ralf J.; Boehncke, Wolf‐Henning

doi:10.1016/s0140-6736(12)60409-7

Cited by 88 publications

(91 citation statements)

References 88 publications

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“…Heparins have a more rapid onset of action, but have to be given parenterally, which is often performed by a healthcare professional if the patient is unwilling. Long term use of heparins can be associated with osteopenia, thrombocytopenia, or idiopathic hepatitis (Ansell & Askin, 2011), and care has to be taken if there is significant renal dysfunction; in addition, hypersensitivity reactions are recognised, which may necessitate a switch of heparin preparation and/ or change to an alternative anticoagulant (Schindewolf et al, 2012). The need to develop novel anticoagulants with better ease of use and safer side effect profiles has recently culminated in several new drugs arriving in clinical practice, which inhibit single coagulation proteins such as activated Factor X or thrombin (Yeh et al, 2015) (Table 1, Figure 1).…”

Section: How Safe Is Anticoagulation Therapy To Use In Those With Chrmentioning

confidence: 99%

Anticoagulation in chronic liver disease

Dhar

Mullish

Thursz

2017

Journal of Hepatology

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Section: How Safe Is Anticoagulation Therapy To Use In Those With Chrmentioning

confidence: 99%

Anticoagulation in chronic liver disease

Dhar

Mullish

Thursz

2017

Journal of Hepatology

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“…6 Most skin lesions occur at the local injection site, but a few cases of necrotizing lesions distant from the heparin injection site have also been reported. 7, 8 In the present case, UFH was injected via the catheter inserted into the right femoral artery before a coronary angiography on hospitalization day 1, and was given continuously via the central venous catheter inserted into the right internal jugular vein until hospitalization day 3.…”

Section: Images In Cardiovascular Medicine Ito K Et Almentioning

confidence: 99%

Bilateral Arm Gangrene Associated With Heparin-Induced Thrombocytopenia After Extracorporeal Cardiopulmonary Resuscitation

Ito

Isogai

Takada

et al. 2018

Circ J

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“…Heparin-induced skin reactions are primarily caused by delayed-type hypersensitivity (DTH; so-called type IV allergic reactions) [86]. DTH reactions to heparin are clearly more common than previously believed, and have been observed in up to 20 % of women who were treated with heparins throughout pregnancy [87].…”

Section: Heparin-induced Allergic Skin Reactionsmentioning

confidence: 99%

Treatment of pregnancy-associated venous thromboembolism - position paper from the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

Linnemann

Scholz

Rott

et al. 2016

Vasa

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Summary: Venous thromboembolism (VTE) is a major cause of maternal morbidity during pregnancy and the postpartum period. However, because there is a lack of adequate study data, management strategies for pregnancy-associated VTE must be deduced from observational studies and extrapolated from recommendations for non-pregnant patients. In this review, the members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH) have summarised the evidence that is currently available in the literature to provide a practical approach for treating pregnancy-associated VTE. Because heparins do not cross the placenta, weight-adjusted therapeutic-dose low molecular weight heparin (LMWH) is the anticoagulant treatment of choice in cases of acute VTE during pregnancy. No differences between once and twice daily LMWH dosing regimens have been reported, but twice daily dosing seems to be advisable, at least peripartally. It remains unclear whether determining dose adjustments according to factor Xa activities during pregnancy provides any benefi t. Management of delivery deserves attention and mainly depends on the time interval between the diagnosis of VTE and the expected delivery date. In particular, if VTE manifests at term, delivery should be attended by an experienced multidisciplinary team. In lactating women, an overlapping switch from LMWH to warfarin is possible. Anticoagulation should be continued for at least 6 weeks postpartum or for a minimum period of 3 months. Although recommendations are provided for the treatment of pregnancy-associated VTE, there is an urgent need for well-designed prospective studies that compare different management strategies and defi ne the optimal duration and intensity of anticoagulant treatment. Anticoagulant therapy during pregnancyLow-molecular-weight heparins (LMWH) are considered the anticoagulants of choice in pregnancy-associated VTE because LMWH do not cross the placenta and do not appear at signifi cant levels in breast milk. Although a Cochrane Review stated that there was no evidence from randomised controlled trials regarding the effi cacy of anticoagulant therapy for DVT in pregnancy [2], two systemic reviews of LMWH use in pregnant women have confi rmed their efficacy and safety, which were consistent with those in nonpregnant women [3,4]. Compared to unfractionated heparin (UFH), LMWH were associated with a substantially lower risk of adverse side eff ects, such as heparin-induced thrombocytopenia (HIT), haemorrhage, and osteoporosis [3 -7]. However, UFH may be considered an alternative if LMWH cannot be used or if UFH seems to be advantageous over LMWH, e.g., in women at high risk of bleeding complications or in women with severe renal impairment. Women with confi rmed PE and haemodynamic compromise who are candidates for subsequent thrombolysis should also receive UFH during the initial phase until defi nitive treatment decisions are reached [1]. Data obtained from non-pregnant patients have confi rmed that LMWH are at least as eff ective...

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Heparin-induced skin lesions

Cited by 88 publications

References 88 publications

Anticoagulation in chronic liver disease

Anticoagulation in chronic liver disease

Bilateral Arm Gangrene Associated With Heparin-Induced Thrombocytopenia After Extracorporeal Cardiopulmonary Resuscitation

Treatment of pregnancy-associated venous thromboembolism - position paper from the Working Group in Women’s Health of the Society of Thrombosis and Haemostasis (GTH)

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