PMID- 35140192
OWN - NLM
STAT- MEDLINE
DCOM- 20220211
LR  - 20220211
IS  - 1473-5733 (Electronic)
IS  - 0957-5235 (Linking)
VI  - 33
IP  - 2
DP  - 2022 Mar 1
TI  - A challenging case of heparin-induced skin necrosis without thrombocytopenia.
PG  - 134-137
LID - 10.1097/MBC.0000000000001112 [doi]
AB  - Heparin-induced skin necrosis (HISN) is a rare complication of heparin 
      anticoagulation. The condition occurs in various situations, including in 
      heparin-naive and exposed individuals, in areas local or distant from the heparin 
      injection site, and with or without frank thrombocytopenia. We present a case in 
      which a patient treated for a pulmonary embolism with therapeutic unfractionated 
      heparin (UFH) develops this adverse event. Symptoms were reversed with cessation 
      of UFH and transition to bivalirudin without surgical debridement. The patient 
      initially had anti-PF4 antibodies present but subsequent testing showed 
      borderline antibodies and a negative serotonin release assay. After starting 
      bivalirudin, the patient was later switched to fondaparinux without further 
      consequences. This case illustrates the pathogenesis of HISN and provides an 
      example of inconsistently abnormal laboratory values. Additionally, it provides 
      two novel exposures the mRNA-1273 vaccine and the immune checkpoint inhibitor 
      pembrolizumab that, to our knowledge, have not been previously reported.
CI  - Copyright (c) 2022 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Chidharla, Anusha
AU  - Chidharla A
AD  - Department of Internal Medicine, University of Illinois College of Medicine at 
      Peoria.
AD  - Department of Medical Oncology, Kansas university Cancer center, Kansas, KS, USA.
FAU - Rapoport, Eliot A
AU  - Rapoport EA
AD  - Department of Internal Medicine, University of Illinois College of Medicine at 
      Peoria.
FAU - Naffakh, Noor
AU  - Naffakh N
AD  - Department of Clinical Pharmacy, OSF Healthcare Saint Francis Medical Center.
FAU - Roberts, Jonathan C
AU  - Roberts JC
AD  - Department of Internal Medicine, University of Illinois College of Medicine at 
      Peoria.
AD  - Bleeding & Clotting Disorders Institute, Peoria, Illinois, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - Blood Coagul Fibrinolysis
JT  - Blood coagulation & fibrinolysis : an international journal in haemostasis and 
      thrombosis
JID - 9102551
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
RN  - EPK39PL4R4 (2019-nCoV Vaccine mRNA-1273)
SB  - IM
MH  - 2019-nCoV Vaccine mRNA-1273
MH  - Anticoagulants/adverse effects
MH  - *Heparin/adverse effects
MH  - Humans
MH  - Necrosis/chemically induced
MH  - *Thrombocytopenia/chemically induced
EDAT- 2022/02/11 06:00
MHDA- 2022/02/12 06:00
CRDT- 2022/02/10 05:31
PHST- 2022/02/10 05:31 [entrez]
PHST- 2022/02/11 06:00 [pubmed]
PHST- 2022/02/12 06:00 [medline]
AID - 00001721-202203000-00008 [pii]
AID - 10.1097/MBC.0000000000001112 [doi]
PST - ppublish
SO  - Blood Coagul Fibrinolysis. 2022 Mar 1;33(2):134-137. doi: 
      10.1097/MBC.0000000000001112.