THE ROLE OF HEPARIN IN THE PREVENTION OF EXTREMITY AND DIGIT NECROSISIN MENINGOCOCCAL PURPURA FULMINANS

In order to gather data regarding the utility of heparin therapy in li miting digit and extremity necrosis resulting from meningococcal purpu ra fulminans in children, we reviewed the charts of 24 pediatric patie nts with PF associated with meningococcal disease. Our study populatio n was comprised of the 13 patients who survived more than 2 days. Clin ical and outcome data were compared between the group of patients who received therapeutic heparin treatment in the initial 72 hours (greate r than or equal to 50 units/kg bolus followed by an infusion, three pa tients) and the group who did not (10 patients). Demographic and initi al clinical and laboratory findings were similar between groups (P > 0 .15). When the two groups were compared for dermatologic and orthopedi c sequelae, the mean number of digits (6.3 vs. 11.1; P = 0.35) and ext remities (1.7 vs. 3.0; P = 0.17) with necrosis was less in those patie nts who received therapeutic doses of heparin, although the difference s were not statistically significant. When only those patients on whom diffuse purpura were noted on admission were compared, these differen ces were greater. This small, retrospective series suggests that hepar in therapy may limit digit and extremity necrosis when used early and in therapeutic doses in meningococcal purpura fulminans. Therefore, a larger, prospective controlled trial is warranted.