Low incidence of heparin‐induced skin lesions in orthopedic surgery patients with low‐molecular‐weight heparins

Schindewolf, Marc; Paulik, Mark; Kroll, Hartmut; Kaufmann, Roland; Wolter, M.; Boehncke, Wolf‐Henning; Lindhoff-Last, Edelgard; Recke, Andreas; Ludwig, Ralf J.

doi:10.1111/cea.13159

Cited by 9 publications

(9 citation statements)

References 46 publications

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“…These include the association of heparin use and osteoporosis 149 and the occurrence of skin lesions. 150 It is generally accepted that long-term use of UFH is associated with a 2.2 to 5% incidence of heparin-induced osteoporotic fracture, an effect that is far less clear for LMWH. The molecular mechanism through which heparin induces bone loss is not completely understood, but it likely involves the resorption of bone by osteoclasts, an effect that is stimulated by heparin.…”

Section: Adverse Effects Of Heparinmentioning

confidence: 99%

The Anticoagulant and Nonanticoagulant Properties of Heparin

et al. 2020

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Heparins represent one of the most frequently used pharmacotherapeutics. Discovered around 1926, routine clinical anticoagulant use of heparin was initiated only after the publication of several seminal papers in the early 1970s by the group of Kakkar. It was shown that heparin prevents venous thromboembolism and mortality from pulmonary embolism in patients after surgery. With the subsequent development of low-molecular-weight heparins and synthetic heparin derivatives, a family of related drugs was created that continues to prove its clinical value in thromboprophylaxis and in prevention of clotting in extracorporeal devices. Fundamental and applied research has revealed a complex pharmacodynamic profile of heparins that goes beyond its anticoagulant use. Recognition of the complex multifaceted beneficial effects of heparin underscores its therapeutic potential in various clinical situations. In this review we focus on the anticoagulant and nonanticoagulant activities of heparin and, where possible, discuss the underlying molecular mechanisms that explain the diversity of heparin's biological actions.

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Section: Adverse Effects Of Heparinmentioning

confidence: 99%

The Anticoagulant and Nonanticoagulant Properties of Heparin

et al. 2020

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“…Skin damage is the most common adverse drug reaction of heparin subcutaneous treatment [10,11]. Heparin-induced skin lesions can manifest in many forms, such as immediate hypersensitivity, skin necrosis caused by immune-mediated thrombocytopenia, and delayed hypersensitivity.…”

Section: Discussionmentioning

confidence: 99%

Localized and Generalized Skin Adverse Drug Reactions to Nadroparin Calcium Injection in 6 Cases of Pregnant Women

Chen

Lan

Sun

et al. 2022

Journal of Healthcare Engineering

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Background. Despite the increasing number of skin adverse drug reactions caused by nadroparin calcium have been reported, mostly, little is known regarding of their details of clinical characteristics, especially for generalized skin adverse drug reactions. We sought to evaluate localized and generalized characteristics of the skin adverse drug reaction to nadroparin calcium injection in pregnant women. Methods. A retrospective study was conducted on 6 pregnant women, who experienced localized and generalized skin adverse drug reactions during long-term nadroparin calcium injection. The patients’ clinical and imaging information were retrieved from medical records. The skin prick test, patch test, and intradermal test were performed after they stopped lactation. Causality assessment of suspected adverse drug reactions was performed on these cases. Results. The average total dose of nadroparin calcium injection in the 6 cases was 64.17 ± 22.66. Localized skin adverse drug reaction, manifested as erythema at the injection point, appeared after 47.5 ± 17.4 days of subcutaneous injection of nadroparin calcium. Generalized urticaria-like lesions, progressing from the injection site on the abdomen, appeared in 5.17 ± 3.60 days after the first appearance of localized reaction, while laboratory test results revealed essential peripheral blood eosinophilia. All rashes in the 6 cases subsided in 2–5 weeks after drug withdrawal. After delivery, 5 of 6 cases received complete skin tests to evaluate drug hypersensitivity. Results presented positive in the intradermal test within 7 days. Both the skin prick test and skin patch test were negative. Localized skin reactions and generalized urticaria-like adverse drug reactions were considered as definitely and probably caused by nadroparin calcium injection, respectively. Conclusion. Subcutaneous injection of nadroparin calcium in pregnant women appears to be at risk of localized and generalized urticaria-like adverse drug reaction. It is important to follow up the pregnant woman during nadroparin calcium injection for evaluating adverse drug reactions. Timely detection of symptoms is pivotal in early diagnosis and treatment of adverse drug reactions.

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“…(14,15) They occur more commonly with unfractionated Heparin (UFH) more than LMWH. (14,16) Skin necrosis may progress, causes sepsis, and eventually death. (17,18) Other adverse effects reported include: major bleeding events (15) , venous/arterial thrombosis complicated HIT syndrome in 30%, osteoporosis, and anaphylaxis.…”

Section: Discussion:-mentioning

confidence: 99%

“…Score <3 indicates low probability, from 4-6 makes it possible, and greater than 6 highly makes it probable for HIT. (16,20) Furthermore, Physicians may require some laboratory test to confirm the diagnosis such as platelets count,platelets aggregation test (PAT), Heparin-induced platelets activation (HIPA) assay, serotonin release assay (SRA) in addition to immunologic tests like heparin anti-bodies by an ELISA. (21,22) The skin lesions appear within 2-15 days after initiation of the therapy, commonly at the injection site, and manifests as erythema and tenderness, which may evolve into blisters formation and plaques of skin necrosis.…”

Section: Discussion:-mentioning

confidence: 99%

Cutaneous Necrosis Induced by Enoxaparin in Old Female With Prosthetic Mitral Valve Replacement After Elective Carpal Tunnel Release

Kalantan¹,

ijar²,

Elyousfi³

2020

IJAR

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The LMW heparin (enoxaparin) has been shown to be effective (LMWH) for preventing venous thromboembolism, particularly in orthopedic surgerythat associated mainlywith restrictionof mobility. This article reviews detailed history, examination and investigations ofa 76-year-old female patient who underwent to elective Carpel Tunnel Syndromerelease andcomplained of rare life-threatening necrotizing skin lesion at the site of Enoxaparin injection, without concomitant Heparin-induced thrombocytopenia.

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Low incidence of heparin‐induced skin lesions in orthopedic surgery patients with low‐molecular‐weight heparins

Cited by 9 publications

References 46 publications

The Anticoagulant and Nonanticoagulant Properties of Heparin

The Anticoagulant and Nonanticoagulant Properties of Heparin

Localized and Generalized Skin Adverse Drug Reactions to Nadroparin Calcium Injection in 6 Cases of Pregnant Women

Cutaneous Necrosis Induced by Enoxaparin in Old Female With Prosthetic Mitral Valve Replacement After Elective Carpal Tunnel Release

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