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

Autor: Marc Schindewolf, M Paulik, Wolf-Henning Boehncke, Manfred Wolter, Edelgard Lindhoff-Last, Ralf Ludwig, Hartmut Kroll, Andreas Recke, Roland Kaufmann
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
0301 basic medicine
Biopsy
030204 cardiovascular system & hematology
ddc:616.07
0302 clinical medicine
Heparin-induced delayed-type hypersensitivity reaction
Risk Factors
Odds Ratio
Immunology and Allergy
Hypersensitivity
Delayed
Orthopedic Procedures
Prospective cohort study
610 Medicine & health
Skin
ddc:616
Orthopedic surgery
medicine.diagnostic_test
Heparin-induced thrombocytopenia
Incidence
Heparin
Middle Aged
DTH
Thrombosis
Female
medicine.drug
Adult
medicine.medical_specialty
medicine.drug_class
Immunology
Low molecular weight heparin
Skin Diseases
Delayed-type drug hypersensitivity reaction to heparin
03 medical and health sciences
Internal medicine
medicine
Humans
Low-molecular-weight heparin
Adverse effect
Aged
business.industry
Heparin
Low-Molecular-Weight
medicine.disease
HIT
030104 developmental biology
Skin biopsy
business
Biomarkers
Zdroj: Clinical and Experimental Allergy, Vol. 48, No 8 (2018) pp. 1016-1024
ISSN: 0954-7894
DOI: 10.7892/boris.123558
Popis: Background Heparins are widely prescribed for prevention and therapy of arterial and venous thromboembolic diseases. Heparin-induced skin lesions are the most frequent adverse effect of subcutaneous heparin treatment in non-surgical patients (7.5%-39.8%); no data exist on surgical patients. Commonly, they are due to a delayed-type hypersensitivity reaction (DTH), but may also be a manifestation of life-threatening heparin-induced thrombocytopenia (HIT). Lesions of both entities resemble initially. The risk of HIT is highest among heparin-anticoagulated orthopedic surgery patients. Objective To determine incidence and causes of heparin-induced skin lesions in major orthopedic surgery patients. Methods In a prospective cohort study, consecutive patients with subcutaneous low-molecular-weight heparin (LMWH) treatment were examined for cutaneous adverse effects. Further diagnostics (skin biopsy, clinical/laboratory assessment for thrombosis, bleeding, HIT, cross-allergies) were performed. Results Six of 316 enrolled patients (1.9%; 95% CI: 0.4%-3.4%) developed heparin-induced skin lesions. All were caused by a DTH reaction, and none was due to HIT or other rare heparin-associated skin diseases. Therapeutic use (dosage) of LMWH was identified as only risk factor (odds ratio: 3.1, 95% CI: 1.4-4.9; P = .00141). In addition to DTH, 5 thromboembolic, 4 major bleeding complications but no cases of HIT or cross-allergies were observed. Conclusions and clinical relevance Orthopedic surgery patients have-unlike non-surgical patients-a low risk for heparin-induced skin lesions during LMWH treatment; all lesions were due to a DTH reaction. The risk for DTH differs considerably between individual patient cohorts. No association with HIT was observed. These data help to tailor anticoagulatory treatment individually and to increase patient safety.
Databáze: OpenAIRE
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