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Incidence and causes of heparin-induced skin lesions
Canadian Medical Association Journal, 10/19/09

Schindewolf M et al. – 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).

• The authors 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, the authors performed a skin biopsy, platelet count measurements, and antiplatelet–factor 4 antibody and allergy testing.

• The authors 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.
• The authors identified the following risk factors for heparin–induced skin lesions: a body mass index greater than 25, duration of heparin therapy longer than 9 days and female sex.

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