Molecular weight determines the frequency of delayed type hypersensitivity reactions to heparin and synthetic oligosaccharides

Autor: Wolf-Henning Boehncke, Marc Schindewolf, Roland Kaufmann, Edelgard Lindhoff-Last, Susanne Alban, Ralf Ludwig
Rok vydání: 2006
Předmět:
Adult
Male
medicine.drug_class
Low molecular weight heparin
Oligosaccharides
Heparinoid
Heparin
Low-Molecular-Weight/*adverse effects/chemistry
Pharmacology
Cross Reactions
Fondaparinux
Lymphocyte Activation
Anticoagulants/*adverse effects/chemistry
Polysaccharides
medicine
Prevalence
Humans
Hypersensitivity
Delayed
Heparinoids
Cells
Cultured
Heparinoids/adverse effects/chemistry
Aged
Skin Tests
Hypersensitivity
Delayed/diagnosis/epidemiology/*etiology
Blood Coagulation Disorders/drug therapy
business.industry
Heparin
Anticoagulant
Anticoagulants
Hematology
Lepirudin
Blood Coagulation Disorders
Heparin
Low-Molecular-Weight
Middle Aged
Molecular Weight
Oligosaccharides/*adverse effects/chemistry
Polysaccharides/adverse effects/chemistry
Nadroparin
Immunology
Heparin/*adverse effects/chemistry
Female
business
medicine.drug
Zdroj: Thrombosis and Haemostasis, Vol. 94, No 6 (2005) pp. 1265-1269
ISSN: 0340-6245
Popis: SummaryEczematous lesions, resulting from type IV sensitizations are well-known and relatively frequent cutaneous adverse effects of s.c. heparin therapy. If anticoagulation is further required intravenous heparin, heparinoids or lepirudin may be used as a substitute. However, these alternatives are not optimal in terms of practicability and/or safety-profiles. As molecular weight of different heparin preparations has repetitively been implied to determine the frequency of sensitization, we hypothesized, that due to its low molecular weight the pentasaccharide fondaparinux may provide a practicable and safe anticoagulant therapy in patients with delayed type hypersensitivity reactions (DTH) to heparin and other oligosaccharides. To test this concept, patients referred for diagnosis of cutaneous reactions after s.c. anticoagulant treatment underwent a series of in vivo skin allergyand challenge-tests with unfractionated heparin, a series of low molecular weight heparins (nadroparin, dalteparin, tinzaparin, enoxaparin and certoparin), the heparinoid danaparoid and the synthetic pentasaccharide fondaparinux. In total, data from twelve patients was evaluated. In accordance with previously published data, we report a high crossreactivity among heparins and heparinoids. In contrast – and in support of our initial hypothesis – sensitization towards the synthetic pentasaccharide fondaparinux was rarely observed. Plotting the cumulative incidence against the determined molecular weight of the individual anticoagulant preparations, shows that molecular weight generally is a key determinant of sensitization towards heparins and other oligosaccharides (r2=0.842, p=0.009). Hence, fondaparinux may be used as a therapeutic alternative in patients with cutaneous DTH relations towards heparin and other polysaccharides.
Databáze: OpenAIRE
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