2004, Número 4
<< Anterior
Med Cutan Iber Lat Am 2004; 32 (4)
Reacciones cutáneas a heparinas de bajo peso molecular
Rodríguez-Vázquez M, García-Arpa M, Vera-Iglesias E, Romero-Aguilera G, Cortina CP
Idioma: Español
Referencias bibliográficas: 49
Paginas: 177-183.
Archivo PDF: 332.26 Kb.
RESUMEN
Las heparinas de bajo peso molecular (HBPM) han desplazado en los últimos años a las heparinas no fraccionadas por sus mejores propiedades farmacodinámicas y su mayor seguridad y comodidad en la administración. Se han descrito diversas lesiones cutáneas adversas, entre ellas urticaria, necrosis cutánea, eczema localizado en el punto de inyección o eczema diseminado. Presuponemos que son reacciones adversas frecuentes y que están infravaloradas en la literatura médica. De especial interés es conocer que las HBPM presentan reacciones cruzadas entre ellas y a su vez con la heparina no fraccionada, por lo que siempre se deben realizar pruebas alérgicas para descartar o confirmar polisensibilizaciones. En este artículo se revisa la literatura acerca de las reacciones cutáneas adversas de las HBPM.
REFERENCIAS (EN ESTE ARTÍCULO)
Wutschert R, Piletta P, Bounameaux H. Adverse skin reactions to low molecular weight heparins: frequency, management and prevention. Drug Saf 1999; 20: 515-25.
Mathelier-Fusade P, Deschamps A, Abuaf N, Leynadier F. Cutaneous reactions to heparin: immunological and clinical aspects. Presse Med 1995; 24: 323-5.
Harenberg J, Hoffmann U, Huhle G, Winkler M, et al. Cutaneous reactions to anticoagulants. Am J Clin Dermatol 2001; 2: 69-75.
Ferahbas A, Uksal U, Kutlugun C, Kontas O. Low-molecular-weight heparin (enoxaparin) in the treatment of lichen planus. J Eur Acad Dermatol Venéreol 2003; 17: 604-5.
Cordoliani F, Saiag P, Guillaume JC. Nécroses cutanées étendues induites par la fraxiparine. Ann Dermatol Venérelo 1987; 114: 1366-8.
Balestra B, Quadri P, Dermarmels Biasiutti F, Furlan M, et al. Low molecular weight heparin. Br J Haematol 1994; 53: 61-3.
Payne SM, Kovacs MJ. Cutaneous dalteparin reactions associated with antibodies of heparin-induced thrombocytopenia. Ann Pharmacother 2003; 37: 655-8.
Lefebvre I, Delaporte E, Dejobert Y, Catteau B, et al. Enoxaparin-induced cutaneous necrosis localized on insulin lipodystrophies. Ann Dermatol Venérelo 1997; 124: 397-400.
Grau E, Real E, Torrecillas T. Skin necrosis induced by low molecular weight heparin: two different mechanism? Thromb Haemost 1995; 73: 972.
Ojeda E, Pérez MC, Mataix R, Arbelo A, et al. Skin necrosis with a low molecular weight heparin. Br J Haematol 1992; 82: 620.
Montserrat I, Lopez D, Zuazu-Jausoro I, Perez M, et al. Low molecular weight subcutaneous heparin-induced skin necrosis. Blood Coagul Fibrinolysis 1990; 1: 751-2.
Real E, Grau E, Rubio M, Torrecilla T. Skin necrosis after subcutaneous low molecular weight heparin injection. Am J Hematol 1995; 49: 253-4.
Taylor AA. Successful use of heparinoids in a pregnancy complicated by allergy to heparin. Br J Obstet Gynaecol 2001; 108: 1011-2.
Koch P, Wagner S, Baum HP. Nécroses cutanées à l’héparine et déficit en protéine C? Ann Deramtol Venereol 1994; 121: S122.
Fried M, Kahanovich S. Enoxaparin-induced skin necrosis. ANN Intern Med 1996; 125:521-2.
Vonderweidt TE. Nécroses cutanées étendues et multiples sons HBPM. Nouv Dermatol 996; 15: 450-1.
Tonn ME, Schaiff RA, Kollef MH. Enoxaparin-associated dermal necrosis: a consequence of cross-reactivity heparin-mediate antibodies. Ann Pharm 1997; 31:323-6.
Plath J, Shultze R, Barz D. Necrotizing skin lesions induced by low molecular weight heparin after local knee arthroplasty. Arch Orthop Trauma Surg 1997; 116: 443-5.
Gibson GE, Gibson LE, Drage LA, Garrett CR, Gertz MA. Skin necrosis secondary to low-molecular weight heparin in a patient with antiphospholipid antibody syndrome. J Am Acad Dermatol 1997; 37: 855-9.
Koch P, Munssinger T, Rupp-John C, Uhl K. Delayed-type hypersensitivity skin reactions caused by subcutaneous unfractionated and low-molecular-weight heparins: tolerance of a new recombinant hirudin. J Am Acad Dermatol 2000; 42: 612-9.
Odeh M, Oliven A. Urticaria and angioedema induced by low-molecular-weight heparin. Lancet 1992; 340: 972-3.
Bircher AJ, Fluckiger R, Buchner SA. Eczematous infiltrated plaques to subcutaneous heparin: a type IV allergic reaction. Br J Dermatol 1990; 123: 507-14.
Manoharan A. Heparin-induced skin reaction with low molecular-weight heparin. Eur J Haematol 1992; 48: 234.
Phillips JK, Majumdar G, Hunt BJ, Savidge GF. Heparin-induced skin reaction due to two different preparations of low molecular weight heparin (LMWH). Br J Haematol 1993; 84: 349-50.
Rasmussen C, Skov L, Da cunha Banf F. Delayed-type hypersensivity to low molecular weight heparin. Am J Contact Deramtitis 1993; 33: 1540-1.
Krasovec M, Kammerer R, Spertini F, Frenk E. Contact dermatitis from heparin gel following sensitization by subcutaneous heparin administration. Contact Dermatitis 1995; 33: 135-6.
Sivakumaran M, Ghosh K, Munks R, Gelsthorpe K, et al. Delayed cutaneous reaction to unfractionated heparin, low molecular weight heparin and danaparoid. Br J Haematol 1994; 86: 893-4.
Sivakumaran M, Ghosh K. Cutaneous reaction to low-molecular-weight heparin. Br J Haematol 2002; 117: 257.
Grassegger A, Fritsch P, Reider N. Delayed-type hypersensitivity and cross-reactivity to heparins and danaparoid: a prospective study. Dermatol Surg Estatus 2001; 27: 47-52.
Mora A, Belchi J, Contreras L, Rubio G. Delayed-type hypersensitivity skin reactions to low molecular weight heparins in a pregnant woman. Contac Dermatitis 2002; 47: 177-8.
Martin L, Machet L, Gironet N, Pouplard C, et al. Eczematous plaques relatedto unfractionated and low-molecular-weight heparins: cross reation with danaparoid but not with desirudin. Contact Dermatitis 2000; 42: 295.
Dacosta A, Mismetti P, Buchmuller A, Guy C, et al. Hypereosinophilia and cutaneous lesions caused by low-molecular-weight heparin. Presse Med 1994; 23: 1540.
Greiner D, Schofer H. Allergic drug exanthema to heparin. Cutaneous reactions to high molecular and fractionated heparin. Hautarzt 1994; 45: 569-72.
Gonzalo Garijo MA, Revenga Arranz F. Type IV hypersensitivity to subcutaneous heparin: a new case. J Investig Allergol Clin Immunol 1996; 6: 388-91.
Figarella I, Barbaud A, Lecompte T, De Maistre E, et al. Cutaneous delayed hypersensitivity reactions to heparins and heparinoids. Ann Dermatol Venérelo 2001; 128: 25-30.
Poza-Guedes P, González-Pérez R, Canto G. Different patterns of cross-reactivity in non-immediate hypersensitivity to heparins: from localized to systemic reactions. Contact Dermatitis 2002; 4: 244-5.
Koch P, Hindi S, Landwehr D. Delayed allergic skin reactions due to subcutaneous heparin-calcium, enoxaprrin-sodium, pentosan polysulfate and acute skin lesions from systemic sodium-heparin. Contact dermatitis 1996; 34: 156.
Mendez J, Sanchis ME, de la Fuente R, Stolle R, et al. Delayed-type hypersensitivity to subcutaneous enoxaparin. Allergy 1998; 53: 999-1003.
Moreau A, Dompmartin A, Esnault P. Delayed hypersensitivity at the injection sites of a low molecular weight heparin. Contact Dermatitis 1996; 34: 31-4.
Cabañas R, Caballero MT, López-Serrano MC, Diaz R, et al. Delayed hypersensitivity to enoxaparin. Invest Allergol Clin Immnunol 1998; 8: 383-4.
Enrique E, Alijotas J, Cisteró A, San Miguel M, et al. Pacht-test positivity in cutaneous reactions to enoxaparin. Contact Dermatitis 2000; 42: 43.
Córdoba A, Bueno MI, Monterrubio J, Corcho G. Reacción de hipersensibilidad cutánea por enoxaparina. Med Clin 2001; 117: 50.
Harrison SJ, Rafferty I, McColl MD. Manegement of heparin allergy during pregnancy with danaparoid. Blood Coagul Fibrinolysis 2001; 12: 157-9.
Kim KH, Lynfield Y. Enoxaparin-induced generalized exanthem. Cutis 2003; 72: 57-60.
Bircher AJ, Itin PH, Tsakiris DA, Surber C. Delayed hypersensitivity to one low-molecular-weight heparin with tolerance of other low-molecular-weight heparins. Br J Dermatol 1995; 132: 461-3.
Schiffner R, Gläbl A, Landthaler M, Stolz W. Tolerance of desirudin in a patient with generalized eczema after intravenous challenge with heparin and a delayed-type skin reaction to high and low molecular weight heparins and heparinoids. Contact dermatitis 2000; 42: 49.
Eich D, Scharffetter-Kochanek K, Weihrauch J, Kreig T, et al. Calcinosis of the cutis and subcutis: An unusual nonimmunologic adverse reaction to subcutaneous injections of low-molecular-weight calcium-containing heparins. J Am Acad Dermatol 2004; 50: 210-4.
Bosh A, Las heras G, Martín E, Oller G. Skin reaction with low molecular weight heparins. Br J Haematol 1993; 85: 637.
Smith KJ, Rosario-Collazo J, Skelton H. Delayed cutaneous hypersensivity reactions to hirudin. Arch Pathol Lab Med 2001; 125: 1585-7.