title: Skin Necrosis Associated With Heparin-Induced Thrombocytopenia and Thrombosis.
abstract: Skin necrosis is a rare complication of heparin therapy. Strong evidence suggests an immune-mediated mechanism in which heparin-antibody complexes bind to platelets, resulting in platelet aggregation, thromboembolism, and ischemic necrosis. Heparin-induced thrombocytopenia (HIT) may also occur in response to immune-mediated platelet aggregation. The presence, of heparin-dependent antibodies can be confirmed by platelet aggregometry, (14)C-serotonin release assay (SRA), or enzyme-linked immunosorbent assay (ELISA). Clinical suspicion, early detection and immediate cessation of heparin therapy are important in preventing the potentially severe complications of heparin-induced platelet aggregation. Potential therapeutic approaches include plasmapheresis and alternative forms of anticoagulation such as warfarin, aspirin, dipyridamole, or other novel investigational agents.
authors.affiliation: a Division of Hematology/Oncology, Department of Medicine , Cedars-Sinai Medical Center, UCLA School of Medicine , Los Angeles , California , USA.
authors.forename: F J
authors.initials: FJ
authors.lastname: Giles
authors.affiliation: a Division of Hematology/Oncology, Department of Medicine , Cedars-Sinai Medical Center, UCLA School of Medicine , Los Angeles , California , USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Kanemaki
authors.affiliation: a Division of Hematology/Oncology, Department of Medicine , Cedars-Sinai Medical Center, UCLA School of Medicine , Los Angeles , California , USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Otsuki
authors.affiliation: a Division of Hematology/Oncology, Department of Medicine , Cedars-Sinai Medical Center, UCLA School of Medicine , Los Angeles , California , USA.
authors.forename: S I
authors.initials: SI
authors.lastname: Hamburg
authors.affiliation: a Division of Hematology/Oncology, Department of Medicine , Cedars-Sinai Medical Center, UCLA School of Medicine , Los Angeles , California , USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Yamashita
authors.affiliation: a Division of Hematology/Oncology, Department of Medicine , Cedars-Sinai Medical Center, UCLA School of Medicine , Los Angeles , California , USA.
authors.forename: H A
authors.initials: HA
authors.lastname: Koh
authors.affiliation: a Division of Hematology/Oncology, Department of Medicine , Cedars-Sinai Medical Center, UCLA School of Medicine , Los Angeles , California , USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Fuerst
authors.affiliation: a Division of Hematology/Oncology, Department of Medicine , Cedars-Sinai Medical Center, UCLA School of Medicine , Los Angeles , California , USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Kusuanco
authors.affiliation: a Division of Hematology/Oncology, Department of Medicine , Cedars-Sinai Medical Center, UCLA School of Medicine , Los Angeles , California , USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Franco
authors.affiliation: a Division of Hematology/Oncology, Department of Medicine , Cedars-Sinai Medical Center, UCLA School of Medicine , Los Angeles , California , USA.
authors.forename: S W
authors.initials: SW
authors.lastname: Lim
keywords: Skin necrosis; heparin; thrombocytopenia; thrombosis