LOW-MOLECULAR-WEIGHT HEPARIN-INDUCED SKIN NECROSIS

We report a case of low-molecular-weight heparin (LMWH)-induced skin n ecrosis in a patient with chronic lymphatic leukemia. The patient had heparin-PF4 antibodies and the heparin-induced platelet activation (HI PA) test was positive, but platelet counts remained normal. Analysis o f seven cases of LMWH-induced skin necrosis revealed that this complic ation occurred mostly in patients previously exposed to heparin, and t hat severe problems such as thrombocytopenia or thromboembolic complic ations were rare. This is in contrast to skin necrosis induced by unfr actionated heparin (UFH), where a substantially higher number of patie nts suffered from thrombocytopenia and thromboembolism. In addition, m ost patients with UFH-induced skin necrosis were not pretreated with h eparin. Therefore, it is possible that LMWH is less immunogenic than U FH and requires repeated exposure for induction of skin necrosis.