CHOLESTEROL CRYSTAL EMBOLISM IN PATIENTS TREATED WITH LOW-MOLECULAR-WEIGHT HEPARIN

BACKGROUND: Cholesterol crystal embolism is often an iatrogenic compli cation in ulcerated atherosclerosis of the aorta. CASE REPORTS: Two ca ses of multi-organ embolism of cholesterol crystals were histologicall y proven in patients treated with low-molecular-weight heparin. Both p atients had acute renal failure, hypertension with acute pulmonary ede ma, skin necrosis and ischemia of the digestive tract Outcome was favo rable after discontinuing anticoagulants, symptomatic treatment, defin itive hemodialysis and low-dose corticosteroids. DISCUSSION: These two cases are the first reported in the literature of cholesterol crystal embolism occurring during prophylactic treatment with low-molecular-w eight heparin. They demonstrate that there is a risk of severe cholest erol embolism in high-risk patients after administration of low-molecu lar-weight heparin as for non-fractionated heparin, fibrinolytics, art eriography and cardiovascular surgery. low-molecular-weight heparin th us should not be used in patients with a diagnosis of cholesterol crys tal embolism. (C) 1997, Masson, Paris.