Association of heparin-induced skin lesions, intracutaneous tests, and heparin-induced IgG.
BACKGROUND
Cutaneous heparin-induced allergic reactions to subcutaneous heparin may begin 2-5 days after administration. The relation of the delayed-type hypersensitivity and a systemic immunologic response is controversial. The present investigation aimed to analyze the occurrence of thromboembolic complication, pathologic heparin-induced platelet activation (HIPA), and the presence of circulating heparin-induced IgG in patients with heparin-induced skin reactions.


METHODS
Intracutaneous tests, HIPA assay, and heparin-heparin IgG antibodies were performed in nine patients with heparin-induced skin lesions.


RESULTS
Six of eight patients showed positive intracutaneous tests to heparin and to four low-molecular-weight heparins. Three of six heparin-positive patients presented hypersensitivity to a heparinoid, too. Two of three patients had a positive HIPA test and elevated heparin-induced IgG antibodies. Both patients developed complications presenting as heparin-induced skin necrosis or arterial thrombosis. Two of nine patients were treated with danaparoid, 4/9 patients received r-hirudin, and 1/9 received oral coumarin. In 2/9 patients, anticoagulant therapy was stopped, but these patients will receive r-hirudin if indicated.


CONCLUSIONS
On the basis of the coincidence of local and systemic hyperreactivity to heparin and danaparoid, patients with heparin-induced skin lesions should receive r-hirudin, a nonheparin compound, for anticoagulant treatment.
Harenberg
J
J
Department of Medicine, Faculty of Clinical Medicine, University of Heidelberg, Germany.
Huhle
G
G
Wang
L
L
Hoffmann
U
U
Bayerl
C
C
Kerowgan
M
M
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D000991:Antithrombins / Q000009:adverse effects / Q000627:therapeutic use; D002809:Chondroitin Sulfates / Q000009:adverse effects / Q000627:therapeutic use; D003871:Dermatan Sulfate / Q000009:adverse effects / Q000627:therapeutic use; D004338:Drug Combinations; D003875:Drug Eruptions / Q000150:complications / Q000209:etiology* / Q000276:immunology / Q000628:therapy; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000276:immunology; D006497:Heparan Sulfate / Q000009:adverse effects / Q000627:therapeutic use; D024764:Hirudin Therapy; D006629:Hirudins / Q000009:adverse effects; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000209:etiology* / Q000276:immunology; D007074:Immunoglobulin G / Q000097:blood; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation; D012882:Skin Tests; D013921:Thrombocytopenia / Q000209:etiology
D000925:Anticoagulants; D000991:Antithrombins; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D006493:Heparin; D006495:Heparin, Low-Molecular-Weight; D006497:Heparan Sulfate; D006629:Hirudins; D007074:Immunoglobulin G; C035838:danaparoid