Generalised cutaneous necrosis: a complication of low-molecular-weight heparin

Subcutaneous low-molecular-weight heparin (LMWH) injections have a predictable dose-dependent anticoagulant effect and have therefore become popular for the prevention and management of thromboembolic diseases. It was initially hoped that use of the smaller molecule and better dose titration would reduce the incidence of side-effects associated with conventional heparin therapy. However, case reports such as this have demonstrated that LMWHs still have the capacity to cause heparin-induced thrombocytopaenia and heparin-induced thrombocytopaenia with thrombosis, as well as heparin necrosis. To our knowledge, this is the first-ever-reported case of heparin necrosis associated with tinazaparin. Heparin necrosis is characterised by widespread life-threatening cutaneous necrosis and systemic thrombosis, in which fatal progression of disease can only be halted by stopping heparin therapy. As heparin necrosis is an uncommon disorder, in this report we focus on the clinical clues that may help woundcare professionals consider and confirm the diagnosis.