Heparin-induced thrombocytopenia: a rare presentation with skin necrosis
https://doi.org/10.4081/dr.2023.9855
HTML: 1
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Heparin-induced thrombocytopenia is the most clinically relevant non-hemorrhagic complication of heparin and is characterized by the presence of anti-platelet factor 4 (PF4)/heparinimmunoglobulin G (IgG) antibodies. The circulating PF4/heparin- IgG immune complex binds to platelets via their FcyIIa receptors, activating them and promoting their aggregation, with consequent platelet consumption, thrombocytopenia, and thrombotic phenomena. Despite thrombocytopenia, this condition is not typically associated with bleeding complications. Instead, thrombosis is the most serious complication of heparin-induced thrombocytopenia, contributing to increased morbidity and mortality. Thrombotic events can be venous and arterial, such as deep vein thrombosis, pulmonary embolism, myocardial infarction, and thrombotic stroke. Skin necrosis at the site of heparin injections is a rare but well-described manifestation of heparin-induced thrombocytopenia. We report a case of heparin-induced thrombocytopenia presented as skin necrosis, highlighting the importance of recognizing this potentially fatal condition and the need for an immediate cessation of all sources of heparin and its replacement by other anticoagulants.
Ahmed I, Majeed A, Powell R. Heparin induced thrombocytopenia: diagnosis and management update. Postgrad Med J 2007;83:575-82.
Hogan M, Berger J. Heparin-induced thrombocytopenia (HIT): review of incidence, diagnosis, and management. Vasc Med 2020;25:160-73.
Arepally G. Heparin-induced thrombocytopenia. Blood 2017;129:2864-72.
Handschin A, Trentz O, Kock H, et al. Low molecular weight heparin-induced skin necrosis- a systemic review. Langenbecks Arch Surg 2005;390:249-54.
Tietge U, Schmidt H, Jäckel C, et al. LMWH-induced skin necrosis occurring distant from injection sites and without thrombopenia. J Intern Med 1998;243:313-5.
White P, Sadd J, Nensel R. Thrombotic complications of heparin therapy: including six cases of heparin-induced skin necrosis. Ann Surg 1979;190:595-608.
Warkentin T. Heparin-induced skin lesions. Br J Haematol 1996;92:494-7.
Warkentin T, Roberts R, Hirsh J, et al. Heparin-induced skin lesions and other unusual sequelae of the heparin-induced thrombocytopenia syndrome: a nested cohort study. Chest 2005;127:1857-61.
Katsourakis A, Noussios G, Kapoutsis G, et al. Low molecular weight heparin-induced skin necrosis: a case report. Case Rep Med 2011;2011:857391.
Bertrand P, Perbet S, Sapin A, et al. Heparin-induced skin necrosis: HIT-2 without thrombocytopenia. Intensive Care Med 2011;37:172-3.
Warkentin T, Pai M, Linkins L. Direct oral anticoagulants for treatment of HIT: update of Hamilton experience and literature review. Blood. 2017;130:1104-13.
Cuker A, Arepally G, Chong B, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv 2018;2:3360-92.
Supporting Agencies
no financial supportCopyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
