Department of Clinical Pharmacy, School of Pharmacy; Department of Clinical Pharmacy, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Neurology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Indian J Pharmacol. 2023 Sep-Oct;55(5):332-334. doi: 10.4103/ijp.ijp_311_23.
Unfractionated heparin (UH), a commonly used anticoagulant, can rarely cause skin necrosis following heparin-induced thrombocytopenia (HIT). A 38-year-old female, a case of chronic inflammatory demyelinating polyneuropathy (CIDP) admitted to the neurology ward, developed extensive skin necrosis following a change in UH dose at the exact site of UH injection. A sudden fall in the platelet count was observed within 48 h of increasing the UH dose. Necrosis of the outer layer of the skin along with clot formation and inflammation in the inner layers was detected after histopathological evaluation. UH was discontinued, and rivaroxaban was started for the patient as soon as the complication was detected. The patient was discharged in good condition after completing treatment for CIDP without any need for surgical removal of the necrotic tissue. Extensive skin necrosis, as a result of HIT, requires immediate discontinuation of UH and substitution of a nonheparin-based anticoagulation treatment.
未分级肝素（UFH）是一种常用的抗凝剂，在肝素诱导的血小板减少症（HIT）的情况下，很少会导致皮肤坏死。一位 38 岁的女性，患有慢性炎症性脱髓鞘性多发性神经病（CIDP），被收入神经科病房。在 UFH 剂量改变的部位，出现了广泛的皮肤坏死。在增加 UFH 剂量后 48 小时内，血小板计数突然下降。组织病理学评估后发现，皮肤外层出现坏死，内层出现血栓形成和炎症。一旦发现并发症，立即停用 UFH，并为患者开始使用利伐沙班。在完成 CIDP 的治疗后，患者情况良好出院，无需手术切除坏死组织。HIT 导致的广泛皮肤坏死需要立即停用 UFH，并替代非肝素类抗凝治疗。
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