Heparin Skin Necrosis in Heparin-Induced Thrombocytopenia

A 66-year-old woman presented with painful abdominal skin necrosis where she had been injecting subcutaneous enoxaparin 1 week following elective knee arthroplasty (Figure). Her complete blood cell count and basic metabolic panel yielded unremarkable findings. Enoxaparin was discontinued, a direct thrombin inhibitor started. Heparin platelet factor 4 IgG antibody strongly positive (2.065 OD), as the serotonin release assay—findings consistent diagnosis of heparin heparin-induced thrombocytopenia.1Warkentin T.E. Roberts R.S. Hirsh J. Kelton J.G. Heparin-induced lesions other unusual sequelae thrombocytopenia syndrome: nested cohort study.CHEST. 2005; 127: 1857-1861Abstract Full Text PDF PubMed Scopus (115) Google Scholar Ultrasound imaging negative for deep venous thrombosis. The patient discharged on regimen therapeutic rivaroxaban did well without need surgical debridement. is rare presentation that can complicate either low-molecular-weight or unfractionated therapy. Normal counts are common do not preclude diagnosis.