Division of Vascular Medicine and Haemostaseology, Department of Internal Medicine, Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
Lancet. 2012 Nov 24;380(9856):1867-79. doi: 10.1016/S0140-6736(12)60409-7. Epub 2012 May 28.
Heparins are widely used for prophylaxis and treatment of thromboembolic diseases. Besides bleeding complications, heparin-induced skin lesions are the most frequent unwanted adverse effects of subcutaneous heparin treatment. Evidence suggests that these lesions are more common than previously thought. Lesions are most frequently due to either allergic reactions or to possibly life-threatening heparin-induced thrombocytopenia. Early recognition and adequate treatment are highly important, because although both complications initially show a similar clinical picture, their treatment should be fundamentally different. Furthermore, risk factors associated with the patient, drug, and treatment regimen have been identified. We review the clinical range of heparin-induced skin lesions, emphasise evidence and controversies in epidemiology, diagnosis, and differential diagnosis, and discuss the management of patients with these skin lesions.
肝素被广泛用于预防和治疗血栓栓塞性疾病。除了出血并发症外，肝素引起的皮肤损伤是皮下肝素治疗最常见的不良副作用。有证据表明，这些损伤比以前认为的更为常见。这些损伤最常见于过敏反应或可能危及生命的肝素诱导的血小板减少症。早期识别和充分治疗非常重要，因为尽管这两种并发症最初表现出相似的临床症状，但它们的治疗应该是根本不同的。此外，还确定了与患者、药物和治疗方案相关的危险因素。我们回顾了肝素引起的皮肤损伤的临床范围，强调了在流行病学、诊断和鉴别诊断方面的证据和争议，并讨论了这些皮肤损伤患者的处理方法。
