Delayed-type hypersensitivity skin reactions due to heparins and heparinoids. Tolerance of recombinant hirudins and of the new synthetic anticoagulant fondaparinux.
Eczema-like, infiltrated plaques at subcutaneous heparin-injection sites are well-documented side effects of these anticoagulants. They are due to delayed-type hypersensitivity. In 4 patients, patch, intradermal and subcutaneous tests were performed with a panel of unfractionated heparins (UFHs), low-molecular-weight heparins (LMWHs), heparinoids, recombinant hirudins and a new synthetic pentasaccharide anticoagulant fondaparinux sodium, to find safe alternatives. 3 patients were sensitized to all the UFHs and LMWHs. The LMWH tinzaparin sodium and the heparinoid pentosan polysulfate were found to be a possible substitute in patient no. 1 and 2, respectively. The recombinant hirudins and fondaparinux sodium were tolerated without any side effects in all patients tested. Fondaparinux is a synthetic copy of a pentasaccharide sequence in the heparin molecule. It is the first in a new class of antithrombotic agents. Our study suggests that it is a new safe alternative in patients with eczema-like, infiltrated plaques at subcutaneous heparin-injection sites.
Koch
Patrick
P
Department of Dermatology, University of Saarland, Homburg/Saar, Germany. hapkoc@uniklinik-saarland.de
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D003429:Cross Reactions; D003937:Diagnosis, Differential; D005260:Female; D000077425:Fondaparinux; D006493:Heparin / Q000009:adverse effects*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects; D006496:Heparinoids / Q000009:adverse effects; D024764:Hirudin Therapy; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D011134:Polysaccharides; D012882:Skin Tests
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D006496:Heparinoids; D011134:Polysaccharides; D006493:Heparin; D000077425:Fondaparinux