Incidence and causes of heparin-induced skin lesions
Incidence and causes of heparin-induced skin lesions
复制标题
DOI：
10.1503/cmaj.081729
复制
发表时间：
2009-10-13
影响因子：
14.6
通讯作者：
Ludwig, Ralf J.
中科院分区：
文献类型：
--
作者：
Schindewolf, Marc;Schwaner, Svantje;Ludwig, Ralf J.
背景：关于肝素诱导的皮肤病变的发生率和原因知之甚少。肝素诱导的皮肤病变的2个最常见的原因是免疫介导的肝素诱导的血小板减少症和迟发型超敏反应reacts.Methods：我们前瞻性地检查了连续患者谁接受皮下肝素（最常见的依诺肝素或那屈肝素）肝素诱导的皮肤病变的存在。如果发现了这种病变，我们进行了皮肤活检，血小板计数测量，抗血小板因子4抗体和过敏试验。共有24例患者（7.5%，95%置信区间[CI] 4.7%-10.6%）发生肝素诱导的皮肤病变。迟发型超敏反应被确定为所有24例患者的原因。1例有迟发型超敏反应组织病理学证据的患者抗血小板因子4抗体检测呈阳性。我们确定了以下肝素诱导皮肤病变的危险因素：体重指数大于25（比值比[OR] 4.6，95% CI 1.7-15.3），肝素治疗持续时间超过9天（OR 5.9，95% CI 1.9-26.3）和女性（OR 3.0，95% CI 1.1-8.8）。解释：肝素引起的皮肤损伤相对常见，具有可识别的风险因素，通常由迟发型超敏反应（IV型过敏反应）引起。（临床试验。政府试验注册号NCT 00510432）。
Background: Little is known about the incidence and causes of heparin-induced skin lesions. The 2 most commonly reported causes of heparin-induced skin lesions are immune-mediated heparin-induced thrombocytopenia and delayed-type hypersensitivity reactions.Methods: We prospectively examined consecutive patients who received subcutaneous heparin (most often enoxaparin or nadroparin) for the presence of heparin-induced skin lesions. If such lesions were identified, we performed a skin biopsy, platelet count measurements, and antiplatelet-factor 4 antibody and allergy testing.Results: We enrolled 320 patients. In total, 24 patients (7.5%, 95% confidence interval [CI] 4.7%-10.6%) had heparin-induced skin lesions. Delayed-type hypersensitivity reactions were identified as the cause in all 24 patients. One patient with histopathologic evidence of delayed-type hypersensitivity tested positive for antiplatelet-factor 4 antibodies. We identified the following risk factors for heparin-induced skin lesions: a body mass index greater than 25 (odds ratio [OR] 4.6, 95% CI 1.7-15.3), duration of heparin therapy longer than 9 days (OR 5.9, 95% CI 1.9-26.3) and female sex (OR 3.0, 95% CI 1.1-8.8).Interpretation: Heparin-induced skin lesions are relatively common, have identifiable risk factors and are commonly caused by a delayed-type hypersensitivity reaction (type IV allergic response). (Clinical Trials. gov trial register no. NCT00510432.)