Related Experiment Video
Updated: Aug 20, 2026
A Standardized Procedure of Dressing Management for Toxic Epidermal Necrolysis
Published on: March 14, 2025
Low molecular weight heparin-induced skin necrosis-a systematic review
A E Handschin1, O Trentz, H J Kock
1Division of Trauma Surgery, University Hospital of Zürich, Raemistrasse 100, 8091, Zürich, Switzerland. alexander.handschin@usz.ch
Background:
Low molecular weight heparins (LMWHs) are currently used as a standard for anti-thrombotic therapy. Skin necrosis caused by LMWH is a rare and probably under-reported complication. The aim of our systematic review is to analyse the present literature for cases of LMWH-induced skin necrosis, emphasising the pathogenesis, clinical pattern, and management of this rare side effect.
Methods:
We performed a Medline literature search (PubMed database) and manual cross-referencing to identify all articles related to LMWH-induced skin necrosis. Data were analysed for type of LMWH used, time until skin necrosis occurred, localisation, size, laboratory findings, switch anticoagulant, complications, and outcome. Additionally, the case of a patient from our hospital is presented.
Results:
We included a total of 20 articles (21 cases) reporting on LMWH-induced skin necrosis. Skin necrosis occurred locally and distant from the injection site. Heparin-induced antibodies were frequently observed (positive 9/11 articles, negative 2/11). However, severe thrombocytopenia (platelet count <100,000 cells/ml) occurred in only four cases, while platelet count remained normal in 50% of the cases. After patients had been switched to other anti-thrombotic drugs, the clinical course was usually benign; however, reconstructive surgery was necessary in two cases.
Conclusion:
LMWH-induced skin necrosis may occur as part of the heparin-induced thrombocytopenia (HIT) syndrome, but other pathomechanisms, including allergic reactions and local trauma, may also be involved. When HIT is excluded, unfractionated heparin is a safe switch anticoagulant. Otherwise, non-heparin preparations such as hirudin or fondaparinux should be preferred.
Insights
Low molecular weight heparin (LMWH) can cause skin necrosis, a rare complication. This systematic review analyzes LMWH-induced skin necrosis cases, highlighting its varied causes and management strategies.
Area of Science:
- Pharmacology
- Dermatology
- Hematology
Background:
- Low molecular weight heparins (LMWHs) are standard anticoagulants.
- LMWH-induced skin necrosis is a rare, under-reported complication.
- This review analyzes literature on LMWH-induced skin necrosis, focusing on pathogenesis, clinical presentation, and management.
Observation:
- A systematic review identified 21 cases of LMWH-induced skin necrosis from 20 articles.
- Necrosis occurred both locally and distantly from injection sites.
- Heparin-induced antibodies were frequently observed, but severe thrombocytopenia was rare.
Findings:
- LMWH-induced skin necrosis can be linked to heparin-induced thrombocytopenia (HIT) syndrome.
- Allergic reactions and local trauma are potential alternative pathomechanisms.
- Switching to unfractionated heparin is safe if HIT is excluded; otherwise, non-heparin anticoagulants are preferred.
Implications:
- Understanding LMWH-induced skin necrosis is crucial for safe anticoagulant therapy.
- Prompt diagnosis and appropriate management, including anticoagulant switching, can lead to favorable outcomes.
- Further research into the pathogenesis of LMWH-induced skin necrosis may improve patient care.
Related Concept Videos
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:29Venous Thrombosis III: Interprofessional Care
01:24Healing II: Complications