Abstract
Subcutaneous low molecular weight heparin (LMWH) injection is a prophylactic treatment for deep vein thrombosis after surgery in lower limb before the patient is fully ambulated. This treatment is usually safe. One of the major and rare complications of the LMWH injection is thrombocytopenia, which is usually self-limiting. We present a rare case of patient with thrombocytopenia, induced by subcutaneous injection of LMWH (enoxaparin) that was complicated with a large hematoma at the injection site with subsequential skin necrosis, sepsis with fatal outcome. We would like to emphasize this rare complication of the common prophylactic treatment by LMWH in order to pursue this diagnosis when similar cutaneous manifestation might appear in patients who receive prophylactic treatment with LMWH.
Highlights
Prophylactic treatment of deep venous thrombosis (DVT) is necessary in certain clinical conditions, especially when prolonged bed rest is expected
On the fifth post operative day the patient developed respiratory difficulty accompanied by a low blood pressure (90/40 mmHg), signs of skin necrosis at the site of the previous sub-cutaneous injection of the enoxaparin (Figure 1)
Skin necrosis occurring after administration of a low-molecular-weight heparin is rare, and the pathogenesis of this complication is not well understood
Summary
Prophylactic treatment of deep venous thrombosis (DVT) is necessary in certain clinical conditions, especially when prolonged bed rest is expected. Enoxaparin (enoxaparin sodium), a low molecular weight heparin,is used to treat and prevent deep vein thrombosis. This antithrombotic agent acts on the coagulation factors Xa and IIa and prevents the conversion of prothrombin to thrombin and of thrombin to fibrin. A complication of massive skin necrosis following subcutaneous enoxaparin administration is rare. This adverse effect of LMWH treatment should be diagnosed because of its potential fatality. On the fifth post operative day the patient developed respiratory difficulty accompanied by a low blood pressure (90/40 mmHg), signs of skin necrosis at the site of the previous sub-cutaneous injection of the enoxaparin (Figure 1). On the 28th day of hospitalization the patient died due to septic shock
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