[Skin and mucosal ulcerations in heparin-induced thrombocytopenia (HIT) II].
About 0.1-2% of patients receiving heparin develop heparin-induced thrombocytopenia type II (HIT II) which is caused by antibodies directed against heparin-platelet factor 4 (PF4) complexes. Activation of thrombocytes and endothelial cells can lead to thrombocytopenia, venous and arterial thrombosis or thromboembolic events 10-14 days after the first dose. HIT II has a high mortality rate because of pulmonary emboli, cerebrovascular accidents, myocardial and limb infarctions. A 55-year-old patient with HIT II presented with arterial and venous thromboses and a silent myocardial infarction. In addition, he showed extensive skin and mucosal necrosis, an uncommon complication. Rheologic therapy with danaparoid Natrium, alprostadil alfadex and acetylsalicylic acid in combination with percutaneous transluminal angioplasties as well as local and systemic antiinflammatory therapy prevented further progression of the disease.
Helbig
D
D
Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 Essen.
Hillen
U
U
Grabbe
S
S
Dissemond
J
J
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000187:drug effects; D019226:Oral Ulcer / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy; D012883:Skin Ulcer / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy
D000893:Anti-Inflammatory Agents; D006493:Heparin