PMID- 34861027
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20211206
IS  - 8755-1225 (Print)
IS  - 1549-4810 (Electronic)
IS  - 1549-4810 (Linking)
VI  - 35
IP  - 1
DP  - 2019 Feb
TI  - Hepatotoxicity With Elevated Bilirubin Secondary to Prophylactic Doses of 
      Unfractionated Heparin: A Case Report and Review of Heparin-Induced 
      Hepatotoxicity.
PG  - 36-40
LID - 10.1177/8755122518803363 [doi]
AB  - Objective: To report a case of heparin-induced hepatotoxicity in a patient 
      without prior liver dysfunction who received prophylactic doses of unfractionated 
      heparin (UFH). Case Summary: A 70-year-old man with no prior liver dysfunction 
      was admitted to the hospital for presyncope, secondary to dehydration, and 
      new-onset congestive heart failure. Prophylactic UFH was initiated for deep vein 
      thrombosis prophylaxis. Within 2 days, he developed increases in aspartate 
      aminotransferase and alanine aminotransferase. By day 4, aspartate 
      aminotransferase and alanine aminotransferase were greater than 5 and 9 times the 
      upper limit of normal, respectively. Alkaline phosphatase and bilirubin were 
      markedly elevated as well. UFH was discontinued on day 4, and liver enzymes 
      subsequently normalized. Discussion: Hepatotoxicity, defined as increases in 
      transaminases greater than 3 times the upper limit of normal, is relatively 
      rare-estimated to occur in only 5% of those receiving therapy with UFH. 
      Concurrent elevations in bilirubin have rarely been reported. Enzymes typically 
      begin to rise after 4 to 5 days of UFH use and return to normal within 2 weeks of 
      discontinuation. Previously published case reports of heparin-induced 
      hepatotoxicity have occurred with therapeutic doses of either UFH or 
      low-molecular-weight heparins. Conclusions: Heparin-induced hepatotoxicity may 
      occur more rapidly than previously described, and even with the use of 
      prophylactic doses of UFH. Given their widespread use, it is important for 
      clinicians to consider heparins in their differential as a potential cause of 
      hepatotoxicity especially in patients without underlying hepatic disease.
CI  - (c) The Author(s) 2018.
FAU - Bosco, Michael
AU  - Bosco M
AUID- ORCID: 0000-0003-4196-6592
AD  - James J. Peters VA Medical Center, Bronx, NY, USA.
FAU - Kish, Troy
AU  - Kish T
AD  - Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island 
      University, Brooklyn, NY, USA.
LA  - eng
PT  - Case Reports
DEP - 20180928
PL  - United States
TA  - J Pharm Technol
JT  - The Journal of pharmacy technology : jPT : official publication of the 
      Association of Pharmacy Technicians
JID - 8504643
PMC - PMC6313267
OTO - NOTNLM
OT  - clinical pharmacology
OT  - heparin
OT  - hepatotoxicity
OT  - low-molecular-weight heparins
OT  - prophylaxis
OT  - toxicology
COIS- Declaration of Conflicting Interests: The author(s) declared no potential 
      conflicts of interest with respect to the research, authorship, and/or 
      publication of this article.
EDAT- 2019/02/01 00:00
MHDA- 2019/02/01 00:01
PMCR- 2019/09/28
CRDT- 2021/12/03 17:32
PHST- 2021/12/03 17:32 [entrez]
PHST- 2019/02/01 00:00 [pubmed]
PHST- 2019/02/01 00:01 [medline]
PHST- 2019/09/28 00:00 [pmc-release]
AID - 10.1177_8755122518803363 [pii]
AID - 10.1177/8755122518803363 [doi]
PST - ppublish
SO  - J Pharm Technol. 2019 Feb;35(1):36-40. doi: 10.1177/8755122518803363. Epub 2018 
      Sep 28.