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Year : 2023  |  Volume : 55  |  Issue : 5  |  Page : 332-334

Extensive arm skin necrosis following administration of unfractionated heparin

1 Department of Clinical Pharmacy, School of Pharmacy; Department of Clinical Pharmacy, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Neurology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
3 Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran

Correspondence Address:
Laleh Mahmoudi
Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijp.ijp_311_23

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Unfractionated heparin (UH), a commonly used anticoagulant, can rarely cause skin necrosis following heparin-induced thrombocytopenia (HIT). A 38-year-old female, a case of chronic inflammatory demyelinating polyneuropathy (CIDP) admitted to the neurology ward, developed extensive skin necrosis following a change in UH dose at the exact site of UH injection. A sudden fall in the platelet count was observed within 48 h of increasing the UH dose. Necrosis of the outer layer of the skin along with clot formation and inflammation in the inner layers was detected after histopathological evaluation. UH was discontinued, and rivaroxaban was started for the patient as soon as the complication was detected. The patient was discharged in good condition after completing treatment for CIDP without any need for surgical removal of the necrotic tissue. Extensive skin necrosis, as a result of HIT, requires immediate discontinuation of UH and substitution of a nonheparin-based anticoagulation treatment.


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