Archives of Hellenic Medicine

Last update:

24-Jul-2020

Arch Hellen Med, 37(4), July-August 2020, 532-535

CASE REPORT

Enoxaparin-induced skin necrosis without heparin-induced thrombocytopenia

M. Tampaki,¹ V. Antoniadou,¹ C. Klonaris,² M. Samarkos¹
¹First Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, "Laikon" General Hospital, Athens
²Vascular Surgery Unit, First Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, "Laikon" General Hospital, Athens, Greece

We report the case of a 73-year-old female who presented skin necrosis at enoxaparin injection sites after 11 days of treatment. We diagnosed enoxaparin-induced skin necrosis on clinical grounds, as the patient declined biopsy. Fondaparinux was substituted for the enoxaparin, and the lesions were managed conservatively. At follow-up the necrotic lesions had healed to a large degree. This case is uncommon in that laboratory findings excluded the presence of heparin-induced thrombocytopenia (HIT), and therefore the skin necrosis should be attributed to other mechanisms, such as type III hypersensitivity with vasculitis, or repeated local trauma and hemorrhage.

Key words: Anticoagulants, Drug eruptions, Low molecular weight heparin, Skin diseases.