Background
Methods
Results
Case presentation
Review of reported cases in the English and Spanish literature
References | Age | Gender | Agent | Days to lesion | Location | Intervention | Days to resolution |
---|---|---|---|---|---|---|---|
Part I | |||||||
[1] | 62 | F | Enoxaparin | Unknown | Buttock | AC changed to warfarin | 14 |
[1] | 32 | M | Enoxaparin | 14 | Lower extremities | AC discontinued | 7 |
[2] | 75 | M | Dalteparin | 5 | Hands and groin | AC changed to coumadin, died of IC 14 days later | Death |
[2] | 82 | F | Tinzaparin | 6 | Extremities | AC discontinued | 10 |
[2] | 64 | M | Heparin Calcium | 21 | Forearms and ankles | AC continued | Yes, unknown |
[3] | 72 | F | Enoxaparin | 2 | Abdomen and upper extremities | AC changed to oral after planned intervention | 14 |
[3] | 57 | M | Enoxaparin | 3 | Abdomen and upper and lower extremities | Unknown | Unknown |
[4] | 88 | M | Enoxaparin then warfarin | 14 | Left arm and ankle | AC discontinued | 14 |
[5] | 51 | Unknown | Enoxaparin then tinzaparin | 2 | Upper and lower extremities, abdomen | AC discontinued | Unknown |
[6] | 86 | M | Enoxaparin | 1 | Trunk, extremities | AC continued | 30 |
[6] | 87 | M | Enoxaparin | 5 | Limbs and hands | AC continued | 21 |
[6] | 73 | F | Bemiparin then Enoxaparin | 1 | Lower extremities | Changed to rivaroxaban, died 10 days later | Death |
[6] | 72 | M | Bemiparin | 30 | Trunk, legs | AC continued | 21 |
[6] | 82 | M | Enoxaparin | 3 | Arms | AC continued | 21 |
[7] | 68 | M | Enoxaparin | 8 | Hand, neck, and face | Unknown | 14 |
[7] | 78 | M | Enoxaparin | 10 | Knees and forearm | AC continued | 14 |
[8] | 85 | M | Enoxaparin | 3 | Torso and legs | AC discontinued | Unknown |
[9] | 73 | M | Enoxaparin | 14 | Upper extremities | AC continued | 14 |
[10] | 77 | M | Enoxaparin | 3 | Trunk, right hand | AC discontinued | 2 |
[10] | 94 | M | Tinzaparin | 15 | Trunk, limbs | AC discontinued | 10 |
[11] | 59 | F | Enoxaparin | 30 | Dorsal hand | AC continued | 4 |
[12] | 68 | M | Enoxaparin | 1 | Feet, leg, neck, hands dorsum | AC discontinued | Unknown |
[12] | 77 | M | Enoxaparin | 8 | Dorsum of feet, dorsum of hands | AC discontinued | Unknown |
[13] | 88 | F | Enoxaparin | 5 | Legs | AC changed to warfarin | Unknown |
[14] | 87 | F | Enoxaparin | 10 | Knees, forearms, elbows | Unknown | 14 |
[15] | 71 | M | Enoxaparin | 2 | Abdomen | AC discontinued | 7 |
[16] | 90 | M | Enoxaparin | 8 | Left arm and ankle | AC continued | 14 |
[17] | 73 | M | Enoxaparin | 6 | Left palm | AC continued | 14 |
Part II | |||||||
[18] | 63 | M | Enoxaparin | 12 | Lower extremities | AC continued | 3 |
[18] | 74 | M | Enoxaparin | 13 | Lower extremities | AC continued | 3 |
[19] | 83 | M | Warfarin + UFH | 5 | Arms, flank, thighs | Heparin discontinued | Yes, unknown |
[20] | 77 | M | Enoxaparin | 5 | Unknown | Changed to dabigatran | 14 |
[21] | 82 | F | Warfarin | 10 | Extremities | Changed to enoxaparin | Worsening lesions, resolved after all AC stopped |
[22] | 90 | M | Enoxaparin | 8 | Ankle and wrist | AC continued | 14 |
[22] | 65 | M | Enoxaparin | 9 | Lower and upper extremities | Changed to tinzaparin as lesions persisted for 6 weeks on enoxaparin | 14 |
[22] | 64 | M | Enoxaparin | 7 | Lower and upper extremities | AC continued | 21 |
[22] | 89 | M | Enoxaparin | 10 | Lower and upper extremities scalp and back | AC discontinued | 21 |
[22] | 74 | M | Enoxaparin | 20 | Hand and leg | AC discontinued | 14 |
[23] | 71 | M | Enoxaparin | 14 | Forearms, hands, knees | AC continued | Persisting lesions for 6 months, resolved after AC stopped |
[24] | 64 | M | Enoxaparin | 5 | Arms and hands | Dose reduced | 14 |
[25] | 74 | M | Enoxaparin | 5 | Upper and lower extremities, abdomen | AC discontinued | 7 |
[26] | 52 | M | Enoxaparin | 7 | Lower and upper extremities | AC continued | 3 |
[27] | 77 | F | Enoxaparin | 15 | Limbs | AC continued | 14 |
[28] | 77 | F | Enoxaparin | 5 | Hands and shins | AC continued, fatal ICH 4 weeks later | 12 |
[29] | 72 | M | Enoxaparin | 7 | Arm and legs | AC changed to UFH | 7 |
[30] | 59 | F | Enoxaparin | 270 | Legs | AC changed to fondaparinux then rivaroxaban | Unknown |
[30] | 51 | F | Fondaparinux | Unknown | Legs | AC changed to rivaroxaban | 3 |
[31] | 75 | F | Enoxaparin | 3 | Arms, hands, feet | AC held, lesions resolved, AC restarted and lesions re-appeared, improved with steroids, patient had past history of bullous pemphigoid | 28 |
Part III | |||||||
[32] | 60 | M | UFH | 5 | Limbs and trunk | AC continued | Unknown |
[32] | 68 | F | UFH then enoxaparin | 7 | Abdomen, hands, feet | AC changed to rivaroxaban | 21 |
[32] | 64 | M | Enoxaparin, warfarin | 9 | Lower and upper extremities | AC discontinued | 30 |
[32] | 38 | F | UFH | 7 | Chest and ankle | AC discontinued | 7 |
[32] | 72 | F | Enoxaparin | 2 | Forearm | AC discontinued | 2 |
Ref. [33]; Case series of 37 cases, 1985–2015 | 77.4 | M 20 F 17 | LMWH Fondaparinux Sodic heparin Calcic heparin | 8.8 | Limbs and trunk | AC discontinued in 34 cases AC continued in 1 case Unknown in 2 cases | Unknown |
Case currently reported | 62 | M | Enoxaparin | 7 | Calf and hands | AC continued with worsening lesions, after 4 months changed to apixaban | 21 after change to apixaban |
Descriptor | Statistic |
---|---|
Age in years, average ± SD | 72 ± 12 |
Sex % (n) | |
Male | 64% (58) |
Female | 36% (33) |
Anticoagulation drug, % (n) | |
Enoxaparin only | 66% (61) |
Fondaparinux | 12% (11) |
UFH only | 9% (8) |
Bridging heparin + enoxaparin | 6.5% (6) |
Other LMWH or ULMWH | 5.4% (5) |
Coumadin only | 1% (1) |
Time to lesion onset, days, mean ± SD | 7.0 ± 6.4 |
Location % (n) | |
Extremities only | 67.9% (36) |
Extremities +torso | 26.4% (14) |
Face, neck, head included | 5.7% (3) |
Management % (n) | |
Discontinued | 57% (52) |
Continued | 23.1% (21) |
Treatment changed or dose reduced | 14.3% (13) |
Unknown | 5.5% (5) |
Time to resolution, days, mean ± SD | 13.0 ± 7.4 |
If continued any AC | 13.9 ± 7.8 |
Discontinued AC | 12.1 ± 7.9 |