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Sharma V, Bagrodia V. Extensive reticular ecchymosis related to heparin-induced thrombocytopenia. BMJ Case Rep 2024; 17:e260309. [PMID: 38802255 DOI: 10.1136/bcr-2024-260309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Affiliation(s)
- Vishnu Sharma
- Medicine, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Vansh Bagrodia
- Medicine, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
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2
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Rakotonandrasana F, Sendrasoa FA, Rakotomanana AMKA, Andriatahina HFP, Ralimalala VN, Ramily SL, Sata M, Raharolahy O, Andrianarison M, Ranaivo IM, Ramarozatovo LS, Rapelanoro Rabenja F. Bullous Hemorrhagic Dermatosis Induced by Enoxaparin: About a Case in Madagascar. Case Rep Dermatol Med 2023; 2023:5710870. [PMID: 37954538 PMCID: PMC10635747 DOI: 10.1155/2023/5710870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/01/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023] Open
Abstract
Bullous hemorrhagic dermatosis is an adverse reaction occurring within 5 to 21 days after anticoagulation; the diagnosis is to be evoked in the presence of hemorrhagic bullous lesions at a distance from the injection site in the days following the introduction of anticoagulant; this is a diagnosis of exclusion. It is a rare pathology that mainly affects the elderly. A 54-year-old man presented with bullous hemorrhagic lesions on the left upper limb starting at the 4th day after enoxaparin injection, diagnosed as a bullous hemorrhagic dermatosis induced by enoxaparin. We report the first case of bullous hemorrhagic dermatosis induced by enoxaparin in Madagascar.
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Affiliation(s)
| | | | | | | | | | - Samson Léophonte Ramily
- Department of Dermatology, Faculty of Medicine, University of Antananarivo, Antananarivo 101, Madagascar
| | - Moril Sata
- Department of Dermatology, Faculty of Medicine, University of Antananarivo, Antananarivo 101, Madagascar
| | - Onivola Raharolahy
- Department of Dermatology, Faculty of Medicine, University of Antananarivo, Antananarivo 101, Madagascar
| | - Malalaniaina Andrianarison
- Department of Dermatology, Faculty of Medicine, University of Antananarivo, Antananarivo 101, Madagascar
| | - Irina Mamisoa Ranaivo
- Department of Dermatology, Faculty of Medicine, University of Toamasina, Toamasina 501, Madagascar
| | - Lala Soavina Ramarozatovo
- Department of Dermatology, Faculty of Medicine, University of Antananarivo, Antananarivo 101, Madagascar
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Liu L, Zheng H, Chen S, Wang S, Yang M. Heparin-induced thrombocytopenia associated with low-molecular-weight heparin: clinical feature analysis of cases and pharmacovigilance assessment of the FAERS database. Front Pharmacol 2023; 14:1247253. [PMID: 37808193 PMCID: PMC10552922 DOI: 10.3389/fphar.2023.1247253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
Background: Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) are commonly used anticoagulants for the management of arterial and venous thromboses. However, it is crucial to be aware that LMWH can, in rare cases, lead to a dangerous complication known as heparin-induced thrombocytopenia (HIT). The objective of this study was to evaluate the pharmacovigilance and clinical features of HIT associated with LMWH, as well as identify treatment strategies and risk factors to facilitate prompt management. Methods: We extracted adverse event report data from the FDA Adverse Event Reporting System (FAERS) database for pharmacovigilance assessment. Case reports on LMWH-induced thrombocytopenia dated up to 20 March 2023 were collected for retrospective analysis. Results: Significantly elevated reporting rates of HIT were shown in adverse event (AE) data of LMWHs in the FAERS database, while tinzaparin had a higher proportional reporting ratio (PRR) and reporting odds ratio (ROR) than other LMWHs, indicating a greater likelihood of HIT. Case report analysis indicated that a total of 43 patients showed evidence of LMWH-induced thrombocytopenia with a median onset time of 8 days. Almost half of the events were caused by enoxaparin. LMWHs were mainly prescribed for the treatment of embolism and thromboprophylaxis of joint operation. Patients with a history of diabetes or surgery appeared to be more susceptible to HIT. Clinical symptoms were mostly presented as thrombus, skin lesion, and dyspnea. Almost 90% of the patients experienced a platelet reduction of more than 50% and had a Warkentin 4T score of more than 6, indicating a high likelihood of HIT. In all patients, LMWHs that were determined to be the cause were promptly withdrawn. Following the discontinuation of LMWHs, almost all patients were given alternative anticoagulants and eventually achieved recovery. Conclusion: LMWH-induced thrombocytopenia is rare but serious, with increased risk in patients with diabetes or a surgical history. Prompt recognition and management are crucial for the safe use of LMWHs.
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Affiliation(s)
- Leping Liu
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong Zheng
- Department of Pediatrics, The Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shanshan Chen
- Department of Pharmacy, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Shengfeng Wang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Postdoctoral Research Station of Clinical Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- MOE Key Lab of Rare Pediatric Diseases, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Minghua Yang
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- MOE Key Lab of Rare Pediatric Diseases, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Clinical Research Center of Pediatric Cancer, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
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Zhu Y, Luo S, Zeng C, Huang B. Ventricular septal rupture after acute myocardial infarction in a patient with venous thromboembolism complicated by thrombocytopenia: A case report. Clin Case Rep 2023; 11:e7059. [PMID: 36911635 PMCID: PMC9994429 DOI: 10.1002/ccr3.7059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/30/2023] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
A woman that suffered burns previously presented with leg swelling and was diagnosed with venous thromboembolism. Heparin was given until she suddenly developed myocardial infarction. Ventricular septal rupture was detected and managed by transcatheter closure. She developed massive bleeding and extensive thrombosis that made treatment paradoxical and eventually died.
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Affiliation(s)
- Yuansong Zhu
- Department of Cardiology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Suxin Luo
- Department of Cardiology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Chun Zeng
- Department of Radiology The First Affiliated Hospital of Chongqing Medical University Chongqing China
| | - Bi Huang
- Department of Cardiology The First Affiliated Hospital of Chongqing Medical University Chongqing China
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Sun L, Mu Y, Xu L, Han X, Gu W, Zhang M. Transgenerational inheritance of wing development defects in Drosophila melanogaster induced by cadmium. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 231:113224. [PMID: 36587412 DOI: 10.1016/j.ecoenv.2022.113224] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 05/26/2023]
Abstract
The transgenerational inheritance of phenotype induced by environmental factors is a new focus in epigenetic research. In this study, Drosophila melanogaster (F0) was cultured in the medium containing cadmium (Cd, 4.5 mg/kg) from eggs to adults, and offspring (F1-F4) were continuously kept in standard medium (without cadmium). The phenotype analysis showed that cadmium induced developmental defects on wings and apoptosis in the wing disc cells of Drosophila (F0). The wing defects were transmitted for at least four generations even without Cd afterwards. And the effect on the mRNA expression of wing development related genes (shg, omb, F-actin, Mekk1) can be maintained for at least two or three generations. More importantly, under cadmium stress, the post-translational modification (PTM) on the histones H3K4me3 in the third instar larvae and ovaries or testes of adult flies increased significantly, while the levels of H3K9me3 and H3K27me3 decreased significantly. The expression of histone methylation related genes (dSet-1, ash1, Lsd1) increased significantly and these changes can be transmitted to offspring from one or two generations in ovaries or testes. These results suggest that the phenotypic defects of wings caused by cadmium can be inherited to the offspring, and this transgenerational inheritance effect may be related to the epigenetic regulation of histone methylation. Therefore, the adaptability of offspring should be considered when evaluating the toxicity and environmental risk of cadmium.
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Affiliation(s)
- Liran Sun
- College of Life Sciences, Shaanxi Normal University, Xi'an 710119, China.
| | - Yun Mu
- College of Life Sciences, Shaanxi Normal University, Xi'an 710119, China.
| | - Lu Xu
- College of Life Sciences, Shaanxi Normal University, Xi'an 710119, China.
| | - Xiaobing Han
- College of Life Sciences, Shaanxi Normal University, Xi'an 710119, China.
| | - Wei Gu
- College of Life Sciences, Shaanxi Normal University, Xi'an 710119, China.
| | - Min Zhang
- College of Life Sciences, Shaanxi Normal University, Xi'an 710119, China.
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Trautmann A, Grän F, Stoevesandt J. Delayed-Type Heparin Allergy: Intravenous Tolerance Despite Inflammatory Skin Reaction After Subcutaneous Injection. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2977-2983.e1. [PMID: 35788063 DOI: 10.1016/j.jaip.2022.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/09/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Heparin allergy most frequently manifests as delayed-type hypersensitivity (DTH) causing an itchy inflammatory skin reaction at the site of subcutaneous injection. An important differential diagnosis is circumscribed skin necrosis due to heparin-induced thrombocytopenia. OBJECTIVES An inflammatory skin reaction to subcutaneously injected heparin generally entails the quest for alternative anticoagulation; concerns may particularly arise in an emergency situation requiring intravenous heparin administration. METHODS All heparin DTH cases seen in our department over the last 17 years underwent standardized allergy diagnostics including challenge testing, that is, subcutaneous injection of fondaparinux and intravenous administration of unfractionated heparin (UFH). RESULTS Of a total of 50 patients with confirmed heparin allergy, DTH was found in 48 (96.0%), and immediate-type, presumably IgE-mediated hypersensitivity was diagnosed in only 2 (4.0%). In the 48 DTH cases, intradermal testing revealed broad cross-reactivity between UFH and low-molecular-weight heparins (LMWH) including nadroparin, dalteparin, and enoxaparin. Cross-reactivity with (or concomitant sensitization to) fondaparinux was seen in only 3 (6.3%) cases. Intravenous administration of UFH was tolerated by all 45 patients challenged, despite DTH to UFH and LMWH as demonstrated by intradermal testing. CONCLUSIONS If an inflammatory skin reaction at the site of subcutaneously injected heparin is observed or reported without any evidence of skin necrosis or thrombocytopenia, intravenous administration of UFH seems to be sufficiently safe and may be considered without allergy testing if urgently indicated in an emergency situation. Fondaparinux is the most suitable alternative for subcutaneous application.
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Affiliation(s)
- Axel Trautmann
- Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.
| | - Franziska Grän
- Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany
| | - Johanna Stoevesandt
- Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany
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Saraiva S, Martins M, Sereno S, Ferreira P, Pinto A, Rasteiro C. Cutaneous hypersensitivity reaction to low molecular weight heparins in pregnancy, cross reactivity and prednisolone treatment: A case report. Obstet Med 2022. [DOI: 10.1177/1753495x221102709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In pregnant women, low molecular weight heparin is recommended as the preferred agent for venous thromboembolism prophylaxis and treatment. Despite their widespread application, heparin-induced skin lesions are probably under-reported and under-estimated. We present a case report of a primigravida treated with low molecular weight heparin for deep vein thrombosis, who developed a delayed-type hypersensitivity reaction to enoxaparin, tinzaparin and dalteparin. As the patient was pregnant, treatment options were restricted. Tolerance was achieved with dalteparin with adjuvant administration of prednisolone. An attempt to decrease prednisolone dose triggered delayed-type hypersensitivity reaction recurrence that was solved by keeping the initial prednisolone prescription. To the best of our knowledge, there are no described cases using this approach. In cases of delayed-type hypersensitivity reaction to low molecular weight heparin during pregnancy our case suggests that switching low molecular weight heparin and adjuvant administration of prednisolone can be an option.
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Affiliation(s)
- Susana Saraiva
- Serviço de Obstetrícia do Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Matilde Martins
- Serviço de Obstetrícia do Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Sara Sereno
- Serviço de Obstetrícia do Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Patrícia Ferreira
- Serviço de Obstetrícia do Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Augusta Pinto
- Serviço de Obstetrícia do Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Cátia Rasteiro
- Serviço de Obstetrícia do Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
- Faculdade de Ciências Médicas, Universidade da Beira Interior, Covilhã, Portugal
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Localized and Generalized Skin Adverse Drug Reactions to Nadroparin Calcium Injection in 6 Cases of Pregnant Women. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5622482. [PMID: 35463677 PMCID: PMC9033372 DOI: 10.1155/2022/5622482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
Abstract
Background Despite the increasing number of skin adverse drug reactions caused by nadroparin calcium have been reported, mostly, little is known regarding of their details of clinical characteristics, especially for generalized skin adverse drug reactions. We sought to evaluate localized and generalized characteristics of the skin adverse drug reaction to nadroparin calcium injection in pregnant women. Methods A retrospective study was conducted on 6 pregnant women, who experienced localized and generalized skin adverse drug reactions during long-term nadroparin calcium injection. The patients' clinical and imaging information were retrieved from medical records. The skin prick test, patch test, and intradermal test were performed after they stopped lactation. Causality assessment of suspected adverse drug reactions was performed on these cases. Results The average total dose of nadroparin calcium injection in the 6 cases was 64.17 ± 22.66. Localized skin adverse drug reaction, manifested as erythema at the injection point, appeared after 47.5 ± 17.4 days of subcutaneous injection of nadroparin calcium. Generalized urticaria-like lesions, progressing from the injection site on the abdomen, appeared in 5.17 ± 3.60 days after the first appearance of localized reaction, while laboratory test results revealed essential peripheral blood eosinophilia. All rashes in the 6 cases subsided in 2–5 weeks after drug withdrawal. After delivery, 5 of 6 cases received complete skin tests to evaluate drug hypersensitivity. Results presented positive in the intradermal test within 7 days. Both the skin prick test and skin patch test were negative. Localized skin reactions and generalized urticaria-like adverse drug reactions were considered as definitely and probably caused by nadroparin calcium injection, respectively. Conclusion Subcutaneous injection of nadroparin calcium in pregnant women appears to be at risk of localized and generalized urticaria-like adverse drug reaction. It is important to follow up the pregnant woman during nadroparin calcium injection for evaluating adverse drug reactions. Timely detection of symptoms is pivotal in early diagnosis and treatment of adverse drug reactions.
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9
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A challenging case of heparin-induced skin necrosis without thrombocytopenia. Blood Coagul Fibrinolysis 2022; 33:134-137. [DOI: 10.1097/mbc.0000000000001112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Bai W, Zhang X, Sun S, Wang Q, Li C, Zhang X, Zhao A. Effect of low-molecular-weight heparins on anti-Xa peak levels and adverse reactions in Chinese patients with recurrent spontaneous abortion: a single-center, observational study. BMC Pregnancy Childbirth 2021; 21:683. [PMID: 34620101 PMCID: PMC8495441 DOI: 10.1186/s12884-021-04161-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022] Open
Abstract
Objective To compare three commonly used low-molecular-weight heparins (LWMHs) in the treatment of recurrent spontaneous abortion (RSA) by evaluating the anti-Xa peak levels and adverse reactions. Methods In this single-center, observational study, we enrolled 310 patients with RSA in whom anti-Xa levels were measured during pregnancy. Patients were divided into three groups according to the LMWH they used: the nadroparin group, enoxaparin group and dalteparin group. We compared the peak anti-Xa levels and the coagulation status of each group, and analyzed the incidence of adverse reactions, including local allergy, liver and renal dysfunction, and the impact on platelet. Results Patients in the enoxaparin group had a higher anti-Xa peak level than those in the nadroparin group (0.80 ± 0.22 IU/ml vs. 0.61 ± 0.24 IU/ml; P < 0.0001), although most patients in the three groups reached the target concentration of anti-Xa. Furthermore, patients in the enoxaparin group had a more stable anti-Xa levels during pregnancy. In addition, patients in the nadroparin group had a higher rate of local allergy than those in the enoxaparin group (60.5% vs. 42.5%; P = 0.004) and those in the dalteparin group (60.5% vs. 33.3%; P = 0.002). Further examination by the type of local allergy indicated a dramatic difference in pruritus and induration between the nadroparin group and the other two groups. No difference was found in the incidence of liver and renal dysfunction and thrombocytopenia. Conclusion Compared with nadroparin and daltepatin, enoxaparin showed a better performance regarding anti-Xa levels and the incidence of adverse reactions in the treatment of RSA.
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Affiliation(s)
- Wenxin Bai
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong District, 200127, Shanghai, China
| | - Xinyang Zhang
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong District, 200127, Shanghai, China
| | - Si Sun
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong District, 200127, Shanghai, China
| | - Qiaohong Wang
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong District, 200127, Shanghai, China
| | - Congcong Li
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong District, 200127, Shanghai, China
| | - Xiaoxin Zhang
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong District, 200127, Shanghai, China
| | - Aimin Zhao
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Pudong District, 200127, Shanghai, China.
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Martin MU, Lambert A, Miremont G, Gaiffe A, Agier MS, Studer M, Mahé A, Tebacher M, Cribier B. Bullous haemorrhagic dermatitis induced by heparins and other anticoagulants: 94 cases from French pharmacovigilance centres and a literature review. Ann Dermatol Venereol 2021; 149:45-50. [PMID: 34175142 DOI: 10.1016/j.annder.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/17/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Bullous haemorrhagic dermatitis (BHD) is an uncommon and highly particular side effect of various forms of heparins. METHODS To better characterise the disease, we collected all cases from French Pharmacovigilance centres recorded over a 20-year period (37 cases) and performed a Medline literature search up to June 2020 (57 cases). RESULTS In all, 94 patients were identified (male/female ratio: 2.2) of mean age 73.5±12.1 years (31-94). Patients were treated with enoxaparin (n=66), unfractionated heparin (n=11), fondaparinux (n=10), tinzaparin (n=4), bemiparin (n=1), reviparin (n=1), dalteparin (n=1), and 4 with other anticoagulants: warfarin (n=3) and rivaroxaban (n=1). All cases presented with 1 to more than 100 haemorrhagic vesicles and bullae, distant from the injection sites, located mainly on the lower (75%) or upper limbs (69%). The lesions were asymptomatic, except in 5 patients who had pruritic or painful lesions. The interval between treatment initiation and BHD ranged from 6 hours to 30 days (mean: 8.4±7 days). Biopsy (n=53) showed intraepidermal or subcorneal cavity with red cells (n=39) or junctional blisters (n=10), with eosinophilic infiltrate only rarely. Direct immuno-fluorescence was negative in 19/20 cases and indirect immunofluorescence was negative in 8/8. The outcome was favourable in all cases, including in 12 patients for whom heparin was maintained. A 93-year-old patient died of compressive haematomas unrelated to BHD. We found 5 cases similar to BHD due to other anticoagulants. DISCUSSION This is the largest comprehensive series of this adverse effect due to heparins or, more rarely, to other anticoagulants. Dermatologists must be aware of BHD, since this benign side effect does not necessarily require interruption of treatment. It is rare, considering the large-scale prescription of heparins, and occurs mainly in male patients aged over 70. Although the presentation is highly typical, the physiopathology is difficult to understand, as coagulation parameters are usually normal. Aging, skin fragility or mechanical factors might play a role.
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Affiliation(s)
- M-U Martin
- Centre régional de pharmacovigilance de Strasbourg, HUS, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - A Lambert
- Centre régional de pharmacovigilance de Strasbourg, HUS, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - G Miremont
- Pôle de santé publique, pharmacologie médicale, centre de pharmacovigilance de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - A Gaiffe
- Centre régional de pharmacovigilance de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - M-S Agier
- Centre régional de pharmacovigilance de Tours, 2, boulevard Tonnellé, 37000 Tours, France
| | - M Studer
- Service de dermatologie, centre hospitalier de Colmar, 39, avenue de la Liberté, 68000 Colmar, France
| | - A Mahé
- Service de dermatologie, centre hospitalier de Colmar, 39, avenue de la Liberté, 68000 Colmar, France
| | - M Tebacher
- Centre régional de pharmacovigilance de Strasbourg, HUS, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - B Cribier
- Clinique dermatologique, hôpitaux universitaires et université de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
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Kim S, Fan J, Lee CS, Chen C, Lee M. Sulfonate Hydrogel-siRNA Conjugate Facilitates Osteogenic Differentiation of Mesenchymal Stem Cells by Controlled Gene Silencing and Activation of BMP Signaling. ACS APPLIED BIO MATERIALS 2021; 4:5189-5200. [PMID: 34661086 DOI: 10.1021/acsabm.1c00369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hydrogels have been widely used in bone tissue engineering due to their tunable characteristics that allow facile modifications with various biochemical properties to support cell growth and guide proper cell functions. Herein, we report a design of hydrogel-siRNA conjugate that facilitates osteogenesis via gene silencing and activation of bone morphogenetic protein (BMP) signaling. A sulfonate hydrogel is prepared by modifying chitosan with sulfoacetic acid to mimic a natural sulfated polysaccharide and to provide a hydrogel surface that enables BMP binding. Then, siRNA targeting noggin, an endogenous extracellular antagonist of BMP signaling, is covalently conjugated to the sulfonate hydrogel by visible blue light crosslinking. The sulfonate hydrogel-siRNA conjugate is efficient to bind BMPs and also successfully prolongs the release of siRNA for sustained noggin suppression, thereby resulting in significantly increased osteogenic differentiation. Lastly, demineralized bone matrix (DBM) is incorporated into the sulfonate hydrogel-siRNA conjugate, wherein the DBM incorporation induces noggin expression via a negative feedback mechanism that regulates BMP signaling in DBM. However, simultaneous delivery of siRNA downregulates noggin thus facilitating endogenous BMP activity and enhancing the osteogenic efficacy of DBM. These findings support a promising hydrogel RNA silencing platform for bone tissue engineering applications.
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Affiliation(s)
- Soyon Kim
- Division of Advanced Prosthodontics, University of California, Los Angeles, USA
| | - Jiabing Fan
- Division of Advanced Prosthodontics, University of California, Los Angeles, USA
| | - Chung-Sung Lee
- Division of Advanced Prosthodontics, University of California, Los Angeles, USA
| | - Chen Chen
- Division of Advanced Prosthodontics, University of California, Los Angeles, USA
| | - Min Lee
- Division of Advanced Prosthodontics, University of California, Los Angeles, USA.,Department of Bioengineering, University of California, Los Angeles, USA
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Stingeni L, Bianchi L, Tramontana M, Pigatto PD, Patruno C, Corazza M, Foti C, Fabbrocini G, Micali G, Romita P, Napolitano M, Hansel K. Skin tests in the diagnosis of adverse drug reactions. GIORN ITAL DERMAT V 2020; 155:602-621. [DOI: 10.23736/s0392-0488.20.06698-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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14
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Gelincik A, Brockow K, Çelik GE, Doña I, Mayorga C, Romano A, Soyer Ö, Atanaskovic‐Markovic M, Barbaud A, Torres MJ. Diagnosis and management of the drug hypersensitivity reactions in Coronavirus disease 19: An EAACI Position Paper. Allergy 2020; 75:2775-2793. [PMID: 32511784 PMCID: PMC7300843 DOI: 10.1111/all.14439] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19), a respiratory tract infection caused by a novel human coronavirus, the severe acute respiratory syndrome coronavirus 2, leads to a wide spectrum of clinical manifestations ranging from asymptomatic cases to patients with mild and severe symptoms, with or without pneumonia. Given the huge influence caused by the overwhelming COVID-19 pandemic affecting over three million people worldwide, a wide spectrum of drugs is considered for the treatment in the concept of repurposing and off-label use. There is no knowledge about the diagnosis and clinical management of the drug hypersensitivity reactions that can potentially occur during the disease. This review brings together all the published information about the diagnosis and management of drug hypersensitivity reactions due to current and candidate off-label drugs and highlights relevant recommendations. Furthermore, it gathers all the dermatologic manifestations reported during the disease for guiding the clinicians to establish a better differential diagnosis of drug hypersensitivity reactions in the course of the disease.
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Affiliation(s)
- Aslı Gelincik
- Department of Internal Medicine Division of Immunology and Allergic Diseases Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein Faculty of Medicine Technical University of Munich Munich Germany
| | - Gülfem E. Çelik
- Department of Chest Diseases Division of Immunology and Allergy Ankara University School of Medicine Ankara Turkey
| | - Inmaculada Doña
- Allergy Unit Hospital Regional Universitario de Málaga‐ARADyAL Málaga Spain
- Allergy Research Group Instituto de Investigación Biomédica de Málaga‐IBIMA‐ARADyAL Málaga Spain
| | - Cristobalina Mayorga
- Research Laboratory IBIMA‐Regional University Hospital of Malaga‐UMA‐ARADyAL Malaga Spain
| | - Antonino Romano
- IRCCS Oasi Maria S.S. Troina Italy
- Fondazione Mediterranea G.B. Morgagni Catania Italy
| | - Özge Soyer
- Pediatric Allergy Department Hacettepe University School of Medicine Ankara Turkey
| | | | - Annick Barbaud
- Department of Dermatology and Allergology, Tenon Hospital (AP‐HP) Sorbonne Universities, Pierre et Marie Curie University Paris France
- Institut Pierre Louis d’Epidémiologie et de Santé Publique AP‐HP Sorbonne Université Paris France
| | - Maria Jose Torres
- Allergy Unit Regional University Hospital of Malaga‐IBIMA‐UMA‐BIONAND‐ARADyAL Malaga Spain
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15
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Kajita A, Sato E, Imafuku S. Hypersensitivity due to unfractionated heparin treatment in a pregnant woman. J Dermatol 2020; 47:e419-e421. [PMID: 32783211 DOI: 10.1111/1346-8138.15551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Akie Kajita
- Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Emi Sato
- Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Shinichi Imafuku
- Department of Dermatology, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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16
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Gutiérrez López de Ocáriz X, Castro Quismondo N, Rodríguez Rodríguez M. Dermatosis ampollosa hemorrágica por administración de heparinas de bajo peso molecular. Med Clin (Barc) 2020; 155:137. [DOI: 10.1016/j.medcli.2019.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 11/25/2022]
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17
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Hart C, Bauersachs R, Scholz U, Zotz R, Bergmann F, Rott H, Linnemann B. Prevention of Venous Thromboembolism during Pregnancy and the Puerperium with a Special Focus on Women with Hereditary Thrombophilia or Prior VTE-Position Paper of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH). Hamostaseologie 2020; 40:572-590. [PMID: 32590872 DOI: 10.1055/a-1132-0750] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Venous thromboembolism (VTE) is a major cause of maternal morbidity during pregnancy and the postpartum period. Because there is a lack of adequate study data, management strategies for the prevention of VTE during pregnancy have mainly been deduced from case-control and observational studies and extrapolated from recommendations for non-pregnant patients. The decision for or against pharmacologic thromboprophylaxis must be made on an individual basis weighing the risk of VTE against the risk of adverse side effects such as severe bleeding complications. A comprehensive, multidisciplinary approach is often essential as the clinical scenario is made more complex by the specific obstetric context, especially in the peripartum period. As members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH), we summarize the evidence from the available literature and aim to establish a more uniform strategy for VTE risk assessment and thromboprophylaxis in pregnancy and the puerperium. In this document, we focus on women with hereditary thrombophilia, prior VTE and the use of anticoagulants that can safely be applied during pregnancy and the lactation period.
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Affiliation(s)
- Christina Hart
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Rupert Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt GmbH, Darmstadt, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Ute Scholz
- MVZ Labor Dr. Reising-Ackermann und Kollegen, Zentrum für Blutgerinnungsstörungen, Leipzig, Germany
| | - Rainer Zotz
- Centrum für Blutgerinnungsstörungen und Transfusionsmedizin, Düsseldorf, Germany
| | - Frauke Bergmann
- MVZ Wagnerstibbe, Amedes-Gruppe, Hannover, Lower Saxony, Germany
| | | | - Birgit Linnemann
- Division of Angiology, University Center of Vascular Medicine, University Hospital Regensburg, Regensburg, Germany
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18
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Cancian M, Borella E, D'Onofrio A, Gerosa G, Simioni P, Campello E. Heparin challenge test in patients undergoing cardiac surgery: dealing with heparin allergy. Blood Coagul Fibrinolysis 2020; 31:165-169. [PMID: 32004200 DOI: 10.1097/mbc.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: A history of heparin hypersensitivity in patients undergoing cardiopulmonary bypass surgery poses the dilemma of which anticoagulant to use. Here, we report the successful use of a heparin challenge test in a 66-year-old female candidate for coronary artery bypass graft surgery with a past medical history of enoxaparin type I hypersensitivity after pulmonary embolism. Challenge and desensitization protocols are effectively used for essential antibiotics in patients with severe infections and/or allergies, or patients with aspirin intolerance requiring revascularization for coronary disease. A successful use of desensitization protocols to unfractionated heparin has been previously described in four patients undergoing cardiac surgery with various schemes. However, our case report indicates that a challenge test may also offer a quick, safe and effective approach in patients with a history of hypersensitivity reactions to heparin with inconclusive diagnostic tests and/or whenever the use of alternative heparins is tricky.
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Affiliation(s)
| | | | - Augusto D'Onofrio
- Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
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19
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Gérard A, Levavasseur M, Gaboriau L, Stichelbout M, Staumont-Salle D. [Hemorrhagic bullous dermatosis (HBD): A rare side-effect of heparins]. Ann Dermatol Venereol 2020; 147:446-450. [PMID: 32005507 DOI: 10.1016/j.annder.2019.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/04/2019] [Accepted: 08/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Bullous haemorrhagic dermatosis (BHD) induced by heparin is a rare and benign side effect of which we report two cases. PATIENTS AND METHODS Case 1: an 81-year-old man presented haemorrhagic bullae on the limbs and trunk 7 days after starting enoxaparin. The laboratory haemostasis assessment was normal. A diagnosis was made of BHD induced by enoxaparin and the patient's treatment was switched to apixaban, resulting in a favourable outcome with resolution of the lesions within 15 days. Case 2: a 71-year-old woman hospitalised for pulmonary embolism was given tinzaparin. At two months of treatment, haemorrhagic bullae were observed on her forearms at distance from the injection sites. A diagnosis of BHD induced by tinzaparin was made. Treatment with tinzaparin was continued and the lesions resolved within 15 days. DISCUSSION Heparin-induced BHD is a rare entity initially described in 2006. Ninety-five cases of heparin-induced BHD have been reported. It is characterized by multiple haemorrhagic bullae at a distance from the injection sites. Time to onset of lesions after heparin initiation ranges from 24h to 4 months. Laboratory assessment should be routinely performed to rule out any haemostasis disorders. Lesions subside within 15 days whether heparin is continued or withdrawn. CONCLUSION Heparin-induced BHD is a rare but benign side effect of heparins. In the absence of recommendations, therapeutic management should be adapted to the individual situation.
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Affiliation(s)
- A Gérard
- Service de dermatologie, hôpital Claude-Huriez, CHU de Lille, 59000 Lille, France; Université de Lille, 59000 Lille, France.
| | - M Levavasseur
- Service de dermatologie, hôpital Claude-Huriez, CHU de Lille, 59000 Lille, France; Université de Lille, 59000 Lille, France
| | - L Gaboriau
- Service de pharmacologie, CHU de Lille, Centre régional de pharmacovigilance, 59000 Lille, France
| | - M Stichelbout
- Laboratoire d'anatomie et de pathologie, centre de biopathologie, CHU de Lille, 59000 Lille, France
| | - D Staumont-Salle
- Service de dermatologie, hôpital Claude-Huriez, CHU de Lille, 59000 Lille, France; Université de Lille, 59000 Lille, France
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20
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Mbuyi N, Cunha JS. A Middle-Aged Woman With Necrotic Breast Lesions. Arthritis Care Res (Hoboken) 2019; 73:462-470. [PMID: 31651087 DOI: 10.1002/acr.24099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/22/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Nadine Mbuyi
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Joanne S Cunha
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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21
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Dabas G, De D, Handa S, Aggarwal D. Delayed-type hypersensitivity reaction to enoxaparin in a pregnant woman. Postgrad Med J 2019; 95:506. [PMID: 31431518 DOI: 10.1136/postgradmedj-2019-136464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/01/2019] [Accepted: 05/11/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Garima Dabas
- Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipankar De
- Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Handa
- Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Aggarwal
- Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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22
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Abstract
The color purple can be seen in several types of eruptions including inflammatory dermatoses like lichen planus, infectious dermatoses like ecthyma gangrenosum, neoplasms like Kaposi sarcoma, and vasculitis and vasculopathy. The current review focuses on the clinical appearance, pathophysiology, and treatment of several vasculitides and vasculopathies including capillaritis, cutaneous small-vessel vasculitis, immunoglobulin A (IgA) vasculitis, cryoglobulinemia, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis, polyarteritis nodosum, warfarin-induced skin necrosis, heparin-induced thrombocytopenia, purpura fulminans, antiphospholipid antibody syndrome, calciphylaxis, levamisole-induced vasculopathy, and thrombotic thrombocytopenic purpura. Dermatologists play a central role in treating patients with cutaneous vasculitis and vasculopathy and may have the opportunity to facilitate identification of systemic disease by diagnosing cutaneous vasculitis and vasculopathy.
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Affiliation(s)
- Alexa B Steuer
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Jeffrey M Cohen
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA.
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23
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Prevention and Management of Thromboembolism in Pregnancy When Heparins Are Not an Option. Clin Obstet Gynecol 2019; 61:228-234. [PMID: 29470181 DOI: 10.1097/grf.0000000000000357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Heparins, unfractionated heparin, and low molecular weight heparin, are the preferred anticoagulants in pregnancy. There are circumstances, however, in which an alternative to heparin should be considered. These circumstances include, the presence of heparin resistance, a heparin allergy manifesting as heparin-induced skin reactions or heparin-induced thrombocytopenia, and the presence of a mechanical heart valve. From time to time, the obstetrician is called on to make recommendations about anticoagulants in pregnancy, including in circumstances in which an alternative to heparin has been suggested or is necessary. In this article, these circumstances are reviewed and alternative anticoagulants are discussed.
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24
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Schindewolf M, Paulik M, Kroll H, Kaufmann R, Wolter M, Boehncke W, Lindhoff‐Last E, Recke A, Ludwig RJ. Low incidence of heparin‐induced skin lesions in orthopedic surgery patients with low‐molecular‐weight heparins. Clin Exp Allergy 2018; 48:1016-1024. [DOI: 10.1111/cea.13159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 01/29/2018] [Accepted: 02/22/2018] [Indexed: 12/24/2022]
Affiliation(s)
- M. Schindewolf
- Department of Internal Medicine Division of Hemostaseology Goethe University Hospital Frankfurt Frankfurt am Main Germany
- Division of Vascular Medicine Swiss Cardiovascular Center Inselspital Bern University Hospital Bern Switzerland
| | - M. Paulik
- Department of Internal Medicine Division of Hemostaseology Goethe University Hospital Frankfurt Frankfurt am Main Germany
| | - H. Kroll
- Institute for Transfusion Medicine Dessau Red Cross Blood Transfusion Service NSTOB Dessau Germany
| | - R. Kaufmann
- Department of Dermatology Goethe University Hospital Frankfurt Frankfurt am Main Germany
| | - M. Wolter
- Department of Dermatology Goethe University Hospital Frankfurt Frankfurt am Main Germany
| | - W.‐H. Boehncke
- Division of Dermatology and Venereology Geneva University Hospitals Geneva Switzerland
- Department of Pathology and Immunology University of Geneva Geneva Switzerland
| | - E. Lindhoff‐Last
- Department of Internal Medicine Division of Hemostaseology Goethe University Hospital Frankfurt Frankfurt am Main Germany
- Agaplesion Bethanien Hospital Cardiovascular Centre Bethanien (CCB) Frankfurt am Main Germany
| | - A. Recke
- Department of Dermatology and Lübeck Institute of Experimental Dermatology University of Lübeck Lübeck Germany
| | - R. J. Ludwig
- Department of Dermatology and Lübeck Institute of Experimental Dermatology University of Lübeck Lübeck Germany
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25
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Lamadrid-Zertuche AC, Garza-Rodríguez V, Ocampo-Candiani JDJ. Pigmented purpura and cutaneous vascular occlusion syndromes. An Bras Dermatol 2018; 93:397-404. [PMID: 29924250 PMCID: PMC6001080 DOI: 10.1590/abd1806-4841.20187459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/03/2017] [Indexed: 01/15/2023] Open
Abstract
Purpura is defined as a visible hemorrhage in the skin or mucosa, which is not evanescent upon pressure. Proper classification allows a better patient approach due to its multiple diagnoses. Purpuras can be categorized by size, morphology, and other characteristics. The course varies according to the etiology, as do the diagnostic approach and treatment. This review discusses pigmented purpuras and some cutaneous vascular occlusion syndromes.
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Affiliation(s)
- Ana Cecilia Lamadrid-Zertuche
- Dermatology Department, University Hospital “Dr. José
Eleuterio González”, Universidad Autónoma de Nuevo León,
Nuevo León, México
| | - Verónica Garza-Rodríguez
- Dermatology Department, University Hospital “Dr. José
Eleuterio González”, Universidad Autónoma de Nuevo León,
Nuevo León, México
| | - Jorge de Jesús Ocampo-Candiani
- Dermatology Department, University Hospital “Dr. José
Eleuterio González”, Universidad Autónoma de Nuevo León,
Nuevo León, México
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26
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Kim S, Cui ZK, Kim PJ, Jung LY, Lee M. Design of hydrogels to stabilize and enhance bone morphogenetic protein activity by heparin mimetics. Acta Biomater 2018; 72:45-54. [PMID: 29597024 DOI: 10.1016/j.actbio.2018.03.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 12/21/2022]
Abstract
Although bone morphogenetic protein-2 (BMP-2) is known to be the most potent stimulator available for bone formation, a major barrier to widespread clinical use is its inherent instability and absence of an adequate delivery system. Heparin is being widely used in controlled release systems due to its strong binding ability and protective effect for many growth factor proteins. In this work, we developed a hydrogel surface that can mimic heparin to stabilize BMP-2 and to enhance osteogenesis by introducing heparin-mimicking sulfonated molecules such as poly-vinylsulfonic acid (PVSA) or poly-4-styrenesulfonic acid (PSS), into photo-crosslinkable hydrogel. Bioactivity of BMP-2 was well preserved in the presence of polysulfonates during exposure to various therapeutically relevant stressors. The heparin-mimicking sulfonated hydrogels were effective to bind BMP-2 compared to unmodified MeGC hydrogel and significantly enhanced osteogenic differentiation of encapsulated bone marrow stromal cells (BMSCs) without the addition of exogenous BMP-2. The sulfonated hydrogels were effective in delivering exogenous BMP-2 with reduced initial burst and increased BMSCs osteogenesis induced by BMP-2. These findings suggest a novel hydrogel platform for sequestering and stabilizing BMP-2 to enhance osteoinductive activity in bone tissue engineering. STATEMENT OF SIGNIFICANCE Although bone morphogenetic protein-2 (BMP-2) is believed to be the most potent cytokine for bone regeneration, its clinical applications require supraphysiological BMP dosage due to its intrinsic instability and fast enzymatic degradation, leading to worrisome side effects. This study demonstrates a novel hydrogel platform that mimics a natural protector of BMPs, heparin, to sequester and stabilize BMP-2 for increased osteoinductive signaling. This study will achieve the stabilization of BMPs with prolonged bioactivity by a synthetic heparin mimic that has not been examined previously. Moreover, the heparin mimetic hydrogel surface can augment endogenous BMP activity by sequestering and localizing the cell-produced BMPs. The additional knowledge gained from this study may suggest basis for future development of material-based therapeutics for tissue engineering.
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27
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Cheung YW, Barco S, Mathôt RA, van den Dool EJ, Stroobants AK, Serlie MJ, Middeldorp S, Coppens M. Pharmacokinetics of dabigatran etexilate and rivaroxaban in patients with short bowel syndrome requiring parenteral nutrition: The PDER PAN study. Thromb Res 2017; 160:76-82. [DOI: 10.1016/j.thromres.2017.10.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/23/2017] [Accepted: 10/31/2017] [Indexed: 12/21/2022]
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28
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Schindewolf M, Steindl J, Beyer-Westendorf J, Schellong S, Dohmen PM, Brachmann J, Madlener K, Pötzsch B, Klamroth R, Hankowitz J, Banik N, Eberle S, Müller MM, Kropff S, Lindhoff-Last E. Use of Fondaparinux Off-Label or Approved Anticoagulants for Management of Heparin-Induced Thrombocytopenia. J Am Coll Cardiol 2017; 70:2636-2648. [DOI: 10.1016/j.jacc.2017.09.1099] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 01/18/2023]
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29
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Román Y, de Oliveira Barddal HP, Iacomini M, Sassaki GL, Cipriani TR. Anticoagulant and antithrombotic effects of chemically sulfated fucogalactan and citrus pectin. Carbohydr Polym 2017; 174:731-739. [DOI: 10.1016/j.carbpol.2017.06.110] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/26/2017] [Accepted: 06/27/2017] [Indexed: 12/15/2022]
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30
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Dhar A, Mullish BH, Thursz MR. Anticoagulation in chronic liver disease. J Hepatol 2017; 66:1313-1326. [PMID: 28088580 DOI: 10.1016/j.jhep.2017.01.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/03/2017] [Accepted: 01/04/2017] [Indexed: 02/06/2023]
Abstract
In this Grand Round presentation, the case of a man with decompensated liver disease is described. He subsequently developed a fatal pulmonary embolism, which may not have occurred if he had been prescribed prophylactic anticoagulation to prevent venous thromboembolic disease. The burden of thrombotic disease in those with chronic liver disease is discussed, before a more detailed analysis of the current evidence, safety data, and clinical dilemmas regarding the use of anticoagulation in patients with chronic liver disease. Finally, the future directions within this field are explored.
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Affiliation(s)
- Ameet Dhar
- Division of Digestive Diseases, Department of Surgery and Cancer, St Mary's Hospital Campus, Imperial College London, London, UK
| | - Benjamin H Mullish
- Division of Digestive Diseases, Department of Surgery and Cancer, St Mary's Hospital Campus, Imperial College London, London, UK
| | - Mark R Thursz
- Division of Digestive Diseases, Department of Surgery and Cancer, St Mary's Hospital Campus, Imperial College London, London, UK.
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31
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Mirgh SP, Bhave AA. Enoxaparin Induced Skin Lesions in Pregnancy: A Rare But Clinically Recognizable Association. Indian J Hematol Blood Transfus 2017; 33:278-280. [DOI: 10.1007/s12288-016-0719-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/20/2016] [Indexed: 11/27/2022] Open
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32
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Shim JS, Chung SJ, Kim BK, Kim SH, Lee KS, Yoon YE, Chang YS. Bullous hemorrhagic dermatosis due to enoxaparin use in a bullous pemphigoid patient. Asia Pac Allergy 2017; 7:97-101. [PMID: 28487841 PMCID: PMC5410417 DOI: 10.5415/apallergy.2017.7.2.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/25/2017] [Indexed: 12/04/2022] Open
Abstract
Adverse reactions of subcutaneous low molecular weight heparin or unfractionated heparin could be complications by bleeding, heparin-induced thrombocytopenia, drug-induced liver injury, osteoporosis, and cutaneous reactions. Heparin-induced skin lesions vary from allergic reactions like erythema, urticaria, eczema to intradermal microvascular thrombosis associated with heparin-induced thrombocytopenia. There is a rare cutaneous complication, called bullous hemorrhagic dermatosis. We experienced this rare case of the cutaneous complication caused by enoxaparin. Several tense bullous hemorrhagic lesions occurred after 3 days of enoxaparin in a known bullous pemphigoid patient who had aortic valve replacement surgery with a mechanical prosthesis. The bullous hemorrhagic lesions were regressed after the discontinuation of enoxaparin but recurred after re-administration. The lesions were controlled by the administration of systemic corticosteroid and alternative anticoagulant. To date, less than 20 cases have been reported worldwide. This is the first case of bullous hemorrhagic dermatosis induced by enoxaparin, a low-molecular-weight heparin in Korea. This is also the first case of bullous hemorrhagic dermatosis in a known bullous pemphigoid patient.
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Affiliation(s)
- Ji-Su Shim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Soo Jie Chung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Byung-Keun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Kyu Sang Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Yeonyee E Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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Schindewolf M, Recke A, Zillikens D, Lindhoff-Last E, Ludwig RJ. Nadroparin carries a potentially high risk of inducing cutaneous delayed-type hypersensitivity responses. Contact Dermatitis 2017; 77:35-41. [DOI: 10.1111/cod.12764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/09/2016] [Accepted: 12/21/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Marc Schindewolf
- Division of Haemostaseology, Department of Internal Medicine; Goethe University Hospital; 60590 Frankfurt am Main Germany
- Division of Vascular Medicine, Swiss Cardiovascular Centre; University Hospital Bern; 3010 Bern Switzerland
| | - Andreas Recke
- Department of Dermatology and Lübeck Institute of Experimental Dermatology; University of Lübeck; 23538 Lübeck Germany
| | - Detlef Zillikens
- Department of Dermatology and Lübeck Institute of Experimental Dermatology; University of Lübeck; 23538 Lübeck Germany
| | - Edelgard Lindhoff-Last
- Division of Haemostaseology, Department of Internal Medicine; Goethe University Hospital; 60590 Frankfurt am Main Germany
- Agaplesion Bethanien Hospital, Cardiovascular Centre Bethanien (CCB); 60389 Frankfurt am Main Germany
| | - Ralf J. Ludwig
- Department of Dermatology and Lübeck Institute of Experimental Dermatology; University of Lübeck; 23538 Lübeck Germany
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Xu L, Hu Y, Huang X, Fu J, Zhang J. Heparinized saline versus normal saline for maintaining peripheral venous catheter patency in China: An open-label, randomized controlled study. J Int Med Res 2017; 45:471-480. [PMID: 28415937 PMCID: PMC5536662 DOI: 10.1177/0300060516685203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the effects of heparin saline versus normal saline as locking solution for maintaining patency in peripheral venous catheters in Chinese patients. Methods This open-label, randomized controlled study was conducted in two hepatobiliary surgery wards, where patients received identical treatments, at a tertiary referral hospital. Patients were randomly divided into a normal saline group (NS, 3 ml) or a heparin saline group (HS, 50 IU/ml, 3 ml) for catheter sealing. Results The study enrolled 286 patients and 609 peripheral venous catheters were included in the analysis. The patients in the two groups had no local infections or catheter-related bloodstream infections. There were no significant differences between the two groups in terms of the rate of catheter obstruction, duration time, or the rates of phlebitis, infiltration, and accidental catheter removal. Conclusions No significant differences in the peripheral venous catheter sealing effects were observed between normal saline and heparin saline usage in Chinese patients.
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Affiliation(s)
- Lichun Xu
- 1 School of Nursing, Fudan University, Shanghai, China
| | - Yan Hu
- 1 School of Nursing, Fudan University, Shanghai, China
| | - Xiaojin Huang
- 2 Department of Vascular Surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, China
| | - Jianguo Fu
- 3 Department of Hospital Infection Control, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, China
| | - Jinhui Zhang
- 4 Department of Nursing, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, China
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Cesana P, Scherer K, Bircher AJ. Immediate Type Hypersensitivity to Heparins: Two Case Reports and a Review of the Literature. Int Arch Allergy Immunol 2017; 171:285-289. [DOI: 10.1159/000453525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 11/14/2016] [Indexed: 11/19/2022] Open
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Santana AG, Gracher AHP, Rüdiger AL, Zanchin NIT, Carvalho PC, Cipriani TR, de Arruda Campos Brasil de Souza T. Identification of potential targets for an anticoagulant pectin. J Proteomics 2017; 151:243-250. [DOI: 10.1016/j.jprot.2016.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/25/2016] [Accepted: 06/09/2016] [Indexed: 01/03/2023]
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Prieto-Torres L, Gracia Cazaña T, Pastushenko I, Morales Moya A, Soria J, Ara Martín M. Dermatosis ampollosa hemorrágica a distancia por enoxaparina: un efecto secundario infrecuente en paciente oncológica anticoagulada. Semergen 2016; 42:504-506. [DOI: 10.1016/j.semerg.2015.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 11/27/2022]
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Optimization of chemical sulfation, structural characterization and anticoagulant activity of Agaricus bisporus fucogalactan. Carbohydr Polym 2016; 146:345-52. [DOI: 10.1016/j.carbpol.2016.03.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/08/2016] [Accepted: 03/19/2016] [Indexed: 11/20/2022]
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40
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Barco S, Heuschen CBBCM, Salman B, Brekelmans MPA, Serlie MJ, Middeldorp S, Coppens M. Home parenteral nutrition-associated thromboembolic and bleeding events: results of a cohort study of 236 individuals. J Thromb Haemost 2016; 14:1364-73. [PMID: 27122107 DOI: 10.1111/jth.13351] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/22/2016] [Indexed: 12/12/2022]
Abstract
UNLABELLED Essentials Sparse or outdated studies focus on thrombotic and bleeding risk in home parenteral nutrition (HPN). 236 HPN patients followed at a single center for a total of 684 patient-years were evaluated. Rates of venous thrombosis and major bleeding, and prevalence of vena cava syndrome are provided. Anticoagulants might reduce thrombosis risk, but population-specific safety concerns remain. SUMMARY Background Home parenteral nutrition (HPN) is necessary for patients with intestinal failure. Recurrent catheter-related thrombosis (CRT) is common, leading to infectious complications, pulmonary embolism, vascular access loss and intestinal transplantation. The efficacy and safety of anticoagulants are unknown in this setting and based on sparse and low-quality observational data. Objectives Our aim was to estimate the incidence of thromboembolic, bleeding and anticoagulant-related complications in HPN patients, and evaluate risk factors for first venous thrombosis (VT). Methods This retrospective cohort study included all adult patients followed for long-term HPN at our center between 1986 and 2014. Primary outcomes were symptomatic objectively diagnosed VT, encompassing CRT and venous thromboembolism, and major bleeding. Secondary outcomes were vena cava syndrome and heparin-induced thrombocytopenia or hypersensitivity. Results A total of 236 patients were included (median HPN duration, 17 months) and 136 received anticoagulants at HPN onset (57.6%). Overall, the annual incidence of first VT was 11.4% (95% confidence interval [95% CI], 8.6-14.7%); VT was associated with a personal history of thrombosis (adjusted hazard ratio, 2.22; 95% CI, 1.06-4.64), whereas anticoagulation seemed to account only for a mild protection (adjusted hazard ratio, 0.72; 95% CI, 0.36-1.44). The annual incidence of major bleeding was 4.3% for patients on anticoagulants vs. 1.8% for those off anticoagulants. Vena cava syndrome developed in 20.7% of patients with VT. One patient had isolated heparin-induced thrombocytopenia (0.6%) and four had heparin hypersensitivity (2.5%). Conclusions Patients on HPN have a significant risk of venous thrombosis, major bleeding and vena cava syndrome. Anticoagulants might reduce thrombosis risk, but population-specific safety concerns remain.
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Affiliation(s)
- S Barco
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University, University Medical Center Mainz, Mainz, Germany
| | - C B B C M Heuschen
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - B Salman
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - M P A Brekelmans
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - M J Serlie
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - S Middeldorp
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - M Coppens
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Castellanos-González M, Velasco-Rodríguez D, Mancebo Plaza AB. Dermatosis ampollosa a distancia en pacientes tratados con heparina. Med Clin (Barc) 2016; 146:402-7. [DOI: 10.1016/j.medcli.2015.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/29/2022]
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Seront B, Marot L, Demoulin N, Jadoul M, Morelle J. The Case | Subcutaneous abdominal calcified nodules and severe hyperphosphatemia. Kidney Int 2016; 89:1171-1172. [PMID: 27083299 DOI: 10.1016/j.kint.2015.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/16/2015] [Accepted: 10/23/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Benjamin Seront
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Liliane Marot
- Division of Dermatology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Nathalie Demoulin
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Michel Jadoul
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Johann Morelle
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium.
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Govind B, Gnass E, Merli G, Eraso L. Hemorrhagic bullous dermatosis: a rare heparin-induced cutaneous manifestation. Hosp Pract (1995) 2016; 44:103-107. [PMID: 26928382 DOI: 10.1080/21548331.2016.1159908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Heparin is one of the most widely prescribed medications. Cutaneous reactions distant to the injection site are rare and under-reported in the literature. We present an elderly man with history of CNS lymphoma who underwent treatment of a deep venous thrombosis with enoxaparin and subsequently developed well demarcated bullous lesions within days of heparin initiation. The exact pathophysiology is not well understood. Hemorrhagic bullous dermatosis is a rare cutaneous reaction that is temporally associated with the initiation of heparin products. The handful of cases thus far suggest that regression of these seemingly benign lesions may or may not be associated with dose reduction or discontinuation of heparin products and typically occur within a few weeks. Elderly age appears to be one potential risk factor for development of these rare asymptomatic lesions. Malignancy may have some contributing factor and differentiation between this rare cutaneous manifestation from heparin products and other dermatological findings in patients with malignancy is key. Because of the asymptomatic and self-limiting nature of hemorrhagic bullous dermatoses in the setting of heparin product use, we presume that the reported incidence does not reflect true clinical practice.
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Affiliation(s)
- Bhuvanesh Govind
- a Department of Neurology , Thomas Jefferson University Hospitals Ringgold Standard Institution , Philadelphia , PA , USA
| | - Esteban Gnass
- b Department of Pathology , Thomas Jefferson University Hospitals Ringgold Standard Institution , Philadelphia , PA , USA
| | - Geno Merli
- c Department of Vascular Medicine , Thomas Jefferson University Hospitals Ringgold Standard Institution , Philadelphia , PA , USA
| | - Luis Eraso
- c Department of Vascular Medicine , Thomas Jefferson University Hospitals Ringgold Standard Institution , Philadelphia , PA , USA
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44
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Tolerance of Fondaparinux in Immediate-type Hypersensitivity to Heparins. Am J Med 2015; 128:e21-2. [PMID: 26169891 DOI: 10.1016/j.amjmed.2015.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/18/2015] [Accepted: 06/22/2015] [Indexed: 11/21/2022]
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45
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Meller S, Gerber PA, Kislat A, Hevezi P, Göbel T, Wiesner U, Kellermann S, Bünemann E, Zlotnik A, Häussinger D, Erhardt A, Homey B. Allergic sensitization to pegylated interferon-α results in drug eruptions. Allergy 2015; 70:775-83. [PMID: 25831972 DOI: 10.1111/all.12618] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND The introduction of pegylated interferon (PEG-IFN)-α in the treatment of chronic hepatitis C has led to an increase in sustained virological response. Despite reduced immunogenicity of the pegylated form in comparison with native interferon (IFN)-α, a high frequency of adverse cutaneous reactions has been reported with pegylated IFN-α. Here, we aimed to investigate the immunological mechanisms underlying pegylated IFN-α-induced drug eruptions. METHODS Hepatitis C patients suffering from drug eruptions in association with administration of pegylated interferons were enrolled in the study (n = 22). Subjects were tested for sensitivity to pegylated IFN-α2a , pegylated IFN-α2b , or ribavirin using intradermal, scratch, and/or patch tests, as well as lymphocyte activation tests (LATs). Skin biopsies obtained from pegylated IFN-α-associated exanthemas, as well as from localized inflammatory skin reactions at pegylated IFN-α injection sites, were analyzed for the expression of relevant chemokines by quantitative real-time PCR and immunohistochemistry. RESULTS A subset of patients suffering from pegylated IFN-α-associated exanthemas displayed positive intradermal tests to PEG-IFNs but not to conventional IFN (11/22). In selected patients, this observation correlated with the presence of pegylated IFN-specific T cells (3/11). Chemokine profiles of inflammatory skin reactions at the injection sites reflected an IFN-α-signature, whereas lesional skin of exanthemas showed induction of TH2-associated chemokines. CONCLUSIONS Our results indicate that specific sensitizations are one cause of exanthemas under therapy with PEG-IFNs. Clinical proof-of-concept analyses demonstrate that affected patients may benefit from a switch to conventional, nonpegylated drugs, enabling IFN-α therapy continuation without drug-associated skin eruptions.
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Affiliation(s)
- S. Meller
- Department of Dermatology; Medical Faculty; Heinrich-Heine-University; Duesseldorf Germany
| | - P. A. Gerber
- Department of Dermatology; Medical Faculty; Heinrich-Heine-University; Duesseldorf Germany
| | - A. Kislat
- Department of Dermatology; Medical Faculty; Heinrich-Heine-University; Duesseldorf Germany
| | - P. Hevezi
- Department of Dermatology; Medical Faculty; Heinrich-Heine-University; Duesseldorf Germany
- Physiology and Biophysics; University of California Irvine; Irvine CA USA
| | - T. Göbel
- Clinic of Gastroenterology, Hepatology and Infectiology; Medical Faculty; Heinrich-Heine-University; Duesseldorf Germany
| | - U. Wiesner
- Department of Dermatology; Medical Faculty; Heinrich-Heine-University; Duesseldorf Germany
| | - S. Kellermann
- Department of Dermatology; Medical Faculty; Heinrich-Heine-University; Duesseldorf Germany
| | - E. Bünemann
- Department of Dermatology; Medical Faculty; Heinrich-Heine-University; Duesseldorf Germany
| | - A. Zlotnik
- Physiology and Biophysics; University of California Irvine; Irvine CA USA
| | - D. Häussinger
- Clinic of Gastroenterology, Hepatology and Infectiology; Medical Faculty; Heinrich-Heine-University; Duesseldorf Germany
| | - A. Erhardt
- Clinic of Gastroenterology, Hepatology and Infectiology; Medical Faculty; Heinrich-Heine-University; Duesseldorf Germany
| | - B. Homey
- Department of Dermatology; Medical Faculty; Heinrich-Heine-University; Duesseldorf Germany
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Gouveia AI, Lopes L, Soares-Almeida L, Filipe P. Bullous hemorrhagic dermatosis induced by enoxaparin. Cutan Ocul Toxicol 2015; 35:160-2. [PMID: 25942690 DOI: 10.3109/15569527.2015.1041033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The bullous hemorrhagic dermatosis induced by enoxaparin is a rare adverse reaction, which may be under-reported given its favorable evolution. We report a 71-year-old man who developed hemorrhagic bullae at sites distant from subcutaneous enoxaparin injections. It is important that clinicians be aware of the different adverse reactions of these widely used drugs.
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Affiliation(s)
- Ana Isabel Gouveia
- a Hospital de Santa Maria, University Clinic of Dermatology, Av. Professor Egas Moniz , Lisbon , Portugal and
| | - Leonor Lopes
- a Hospital de Santa Maria, University Clinic of Dermatology, Av. Professor Egas Moniz , Lisbon , Portugal and
| | - Luis Soares-Almeida
- a Hospital de Santa Maria, University Clinic of Dermatology, Av. Professor Egas Moniz , Lisbon , Portugal and.,b Faculdade de Medicina da Universidade de Lisboa, Institute of Molecular Medicine, Research Unit of Dermatology , Lisbon , Portugal
| | - Paulo Filipe
- a Hospital de Santa Maria, University Clinic of Dermatology, Av. Professor Egas Moniz , Lisbon , Portugal and.,b Faculdade de Medicina da Universidade de Lisboa, Institute of Molecular Medicine, Research Unit of Dermatology , Lisbon , Portugal
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Stadler S, Booken N, Schneider SW, Goerdt S, Klemke CD, Utikal J. Acid citrate dextrose extracorporeal photopheresis is an alternative treatment option for patients with heparin allergy. Int J Dermatol 2015; 54:e266-7. [PMID: 25784218 DOI: 10.1111/ijd.12789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 06/10/2014] [Accepted: 06/22/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Simone Stadler
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany.,Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nina Booken
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Stefan W Schneider
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Sergij Goerdt
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Claus-Detlev Klemke
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany
| | - Jochen Utikal
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany. .,Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Loidi Pascual L, Valcayo Peñalba A, Yerani Ruiz de Azúa Ciria A, Yanguas Bayona I. Dermatosis ampollosa hemorrágica a distancia inducida por heparina: descripción de 2 nuevos casos. Med Clin (Barc) 2014; 143:516-7. [DOI: 10.1016/j.medcli.2014.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 01/27/2014] [Accepted: 01/30/2014] [Indexed: 11/24/2022]
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Oliveira JR, Bertolin TC, Andrade D, Oliveira LCG, Kondo MY, Santos JAN, Blaber M, Juliano L, Severino B, Caliendo G, Santagada V, Juliano MA. Specificity studies on Kallikrein-related peptidase 7 (KLK7) and effects of osmolytes and glycosaminoglycans on its peptidase activity. BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2014; 1854:73-83. [PMID: 25448018 DOI: 10.1016/j.bbapap.2014.10.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/20/2014] [Accepted: 10/21/2014] [Indexed: 11/29/2022]
Abstract
KLK7 substrate specificity was evaluated by families of fluorescence resonance energy transfer (FRET) peptides derived from Abz-KLFSSK-Q-EDDnp (Abz=ortho-aminobenzoic acid and Q-EDDnp=glutaminyl-N-[2,4-dinitrophenyl] ethylenediamine), by one bead-one peptide FRET peptide library in PEGA resin, and by the FRET peptide libraries Abz-GXX-Z-XX-Q-EDDnp (Z and X are fixed and random natural amino acids, respectively). KLK7 hydrolyzed preferentially F, Y or M, and its S1' and S2' subsites showed selectivity for hydrophilic amino acids, particularly R and K. This set of specificities was confirmed by the efficient kininogenase activity of KLK7 on Abz-MISLM(↓)KRPPGFSPF(↓)RSSRI-NH2 ((↓)indicates cleavage), hydrolysis of somatostatin and substance P and inhibition by kallistatin. The peptide Abz-NLY(↓)RVE-Q-EDDnp is the best synthetic substrate so far described for KLK7 [kcat/Km=455 (mMs)(-1)] that was designed from the KLK7 substrate specificity analysis. It is noteworthy that the NLYRVE sequence is present in human semaphorin 6B. KLK7 is activated by GAGs, inhibited by neutral salts, and activated by high concentration of kosmotropic salt. Pyroglutamic acid inhibited KLK7 (Ki=33mM) and is present in skin moisturizing factor (124mM). The KLK7 specificity described here and elsewhere reflects its participation in patho-physiological events in skin, the gastrointestinal tract and central nervous system, where KLK7 is significantly expressed.
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Affiliation(s)
- Juliana R Oliveira
- Department of Biophysics, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Thiago C Bertolin
- Department of Biophysics, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Douglas Andrade
- Department of Biophysics, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Lilian C G Oliveira
- Department of Biophysics, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Marcia Y Kondo
- Department of Biophysics, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Jorge A N Santos
- Department of Biophysics, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil; Instituto Federal de Educação, Ciência e Tecnologia do Sul de Minas Gerais, Câmpus Inconfidentes, Brazil
| | - Michael Blaber
- Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Luiz Juliano
- Department of Biophysics, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Beatrice Severino
- Dipartimento di Farmacia, Università degli Studi di Napoli ‟Federico II", Via D. Montesano, 49, 80131, Napoli, Italy
| | - Giuseppe Caliendo
- Dipartimento di Farmacia, Università degli Studi di Napoli ‟Federico II", Via D. Montesano, 49, 80131, Napoli, Italy
| | - Vincenzo Santagada
- Dipartimento di Farmacia, Università degli Studi di Napoli ‟Federico II", Via D. Montesano, 49, 80131, Napoli, Italy
| | - Maria A Juliano
- Department of Biophysics, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.
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Tattersall TL, Thangasamy IA, Reynolds J. Bilateral adrenal haemorrhage associated with heparin-induced thrombocytopaenia during treatment of Fournier gangrene. BMJ Case Rep 2014; 2014:bcr-2014-206070. [PMID: 25315802 DOI: 10.1136/bcr-2014-206070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of bilateral adrenal haemorrhage (BAH) associated with heparin-induced thrombocytopaenia (HIT) in a 61-year-old man admitted to hospital for the treatment of Fournier's gangrene. He presented to hospital with scrotal swelling and fever, and developed spreading erythaema and a gangrenous scrotum. His scrotum was surgically debrided and intravenous broad-spectrum antibiotics were administered. Unfractionated heparin was given postoperatively for venous thromboembolism prophylaxis. The patient deteriorated clinically 8-11 days postoperatively with delirium, chest pain and severe hypertension followed by hypotension and thrombocytopaenia. Abdominal CT scan revealed bilateral adrenal haemorrhage. Antibodies to the heparin-platelet factor 4 complex were present. HIT-associated BAH was diagnosed and heparin was discontinued. Intravenous bivalirudin and hydrocortisone were started, with rapid improvement in clinical status. BAH is a rare complication of HIT and should be considered in the postoperative patient with unexplained clinical deterioration.
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Affiliation(s)
| | - Isaac A Thangasamy
- Department of Urology, University of Queensland, Herston, Queensland, Australia
| | - Jamie Reynolds
- Department of Urology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
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