Incidence and causes of heparin-induced skin lesions

Schindewolf, Marc; Schwaner, Svantje; Wolter, Manfred; Kroll, Hartmut; Recke, Andreas; Kaufmann, Roland; Boehncke, Wolf-Henning; Lindhoff-Last, Edelgard; Ludwig, Ralf J.

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Title		Incidence and causes of heparin-induced skin lesions
Authors		Schindewolf, Marc Schwaner, Svantje Wolter, Manfred Kroll, Hartmut Recke, Andreas Kaufmann, Roland Boehncke, Wolf-Henning Lindhoff-Last, Edelgard Ludwig, Ralf J. show all authors [1 - 9]
Published in		Canadian Medical Association Journal. 2009, vol. 181, no. 8, p. 477-481
Abstract		BACKGROUND: Little is known about the incidence and causes of heparin-induced skin lesions. The 2 most commonly reported causes of heparin-induced skin lesions are immune-mediated heparin-induced thrombocytopenia and delayed-type hypersensitivity reactions. METHODS: We prospectively examined consecutive patients who received subcutaneous heparin (most often enoxaparin or nadroparin) for the presence of heparin-induced skin lesions. If such lesions were identified, we performed a skin biopsy, platelet count measurements, and antiplatelet-factor 4 antibody and allergy testing. RESULTS: We enrolled 320 patients. In total, 24 patients (7.5%, 95% confidence interval [CI] 4.7%-10.6%) had heparin-induced skin lesions. Delayed-type hypersensitivity reactions were identified as the cause in all 24 patients. One patient with histopathologic evidence of delayed-type hypersensitivity tested positive for antiplatelet-factor 4 antibodies. We identified the following risk factors for heparin-induced skin lesions: a body mass index greater than 25 (odds ratio [OR] 4.6, 95% CI 1.7-15.3), duration of heparin therapy longer than 9 days (OR 5.9, 95% CI 1.9-26.3) and female sex (OR 3.0, 95% CI 1.1-8.8). INTERPRETATION: Heparin-induced skin lesions are relatively common, have identifiable risk factors and are commonly caused by a delayed-type hypersensitivity reaction (type IV allergic response).
Keywords		Anticoagulants/administration & dosage/adverse effects — Drug Eruptions/diagnosis/epidemiology/etiology — Female — Follow-Up Studies — Germany/epidemiology — Heparin/administration & dosage/adverse effects — Humans — Incidence — Injections, Subcutaneous — Male — Middle Aged — Prognosis — Prospective Studies — Risk Factors — Thrombocytopenia/chemically induced/complications/epidemiology
Identifiers		DOI: 10.1503/cmaj.081729 PMID: 19786468
Full text		Article - Limited access to UNIGE Other version: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2761438/pdf/1810477.pdf
Citation (ISO format)		SCHINDEWOLF, Marc et al. Incidence and causes of heparin-induced skin lesions. In: Canadian Medical Association Journal, 2009, vol. 181, n° 8, p. 477-481. https://archive-ouverte.unige.ch/unige:29876