Acquired Coagulopathy and Hemorrhage Secondary to Subcutaneous Heparin Prophylaxis
Unfractionated heparin and low-molecular-weight heparins are commonly used as thromboprophylaxis for hospitalized patients. Though generally considered safe at prophylactic doses, cases of catastrophic hemorrhage have been reported. The proposed mechanism involves bioaccumulation of heparin through...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Case Reports in Hematology |
| Online Access: | http://dx.doi.org/10.1155/2018/9501863 |
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| _version_ | 1850163811565174784 |
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| author | Maria Sunseri Tania Ahuja Tanya Wilcox David Green |
| author_facet | Maria Sunseri Tania Ahuja Tanya Wilcox David Green |
| author_sort | Maria Sunseri |
| collection | DOAJ |
| description | Unfractionated heparin and low-molecular-weight heparins are commonly used as thromboprophylaxis for hospitalized patients. Though generally considered safe at prophylactic doses, cases of catastrophic hemorrhage have been reported. The proposed mechanism involves bioaccumulation of heparin through saturation of the rapid-elimination pathway in its metabolism. We present an unusual case of an average-weight man with metastatic melanoma who suffered hemorrhage with syncope and end-organ damage while on prophylactic three times daily unfractionated heparin. Coagulation studies were consistent with heparin toxicity. Despite administration of protamine, the clearance of heparin was remarkably delayed, as demonstrated by serial coagulation studies. We review the suspected risk factors for heparin bioaccumulation and the emerging understanding of this unusual adverse event involving a nearly ubiquitous medication. |
| format | Article |
| id | doaj-art-ed4dc67ee2ff4f14a0899163a3864d7c |
| institution | OA Journals |
| issn | 2090-6560 2090-6579 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Hematology |
| spelling | doaj-art-ed4dc67ee2ff4f14a0899163a3864d7c2025-08-20T02:22:09ZengWileyCase Reports in Hematology2090-65602090-65792018-01-01201810.1155/2018/95018639501863Acquired Coagulopathy and Hemorrhage Secondary to Subcutaneous Heparin ProphylaxisMaria Sunseri0Tania Ahuja1Tanya Wilcox2David Green3Department of Medicine, New York University Langone Health, 550 First Avenue, New York, NY 10016, USADepartment of Pharmacy, New York University Langone Health, 550 First Avenue, New York, NY, USADepartment of Medicine, New York University Langone Health, 550 First Avenue, New York, NY 10016, USADepartment of Medicine, New York University Langone Health, Division of Hematology, 550 First Avenue, New York, NY, USAUnfractionated heparin and low-molecular-weight heparins are commonly used as thromboprophylaxis for hospitalized patients. Though generally considered safe at prophylactic doses, cases of catastrophic hemorrhage have been reported. The proposed mechanism involves bioaccumulation of heparin through saturation of the rapid-elimination pathway in its metabolism. We present an unusual case of an average-weight man with metastatic melanoma who suffered hemorrhage with syncope and end-organ damage while on prophylactic three times daily unfractionated heparin. Coagulation studies were consistent with heparin toxicity. Despite administration of protamine, the clearance of heparin was remarkably delayed, as demonstrated by serial coagulation studies. We review the suspected risk factors for heparin bioaccumulation and the emerging understanding of this unusual adverse event involving a nearly ubiquitous medication.http://dx.doi.org/10.1155/2018/9501863 |
| spellingShingle | Maria Sunseri Tania Ahuja Tanya Wilcox David Green Acquired Coagulopathy and Hemorrhage Secondary to Subcutaneous Heparin Prophylaxis Case Reports in Hematology |
| title | Acquired Coagulopathy and Hemorrhage Secondary to Subcutaneous Heparin Prophylaxis |
| title_full | Acquired Coagulopathy and Hemorrhage Secondary to Subcutaneous Heparin Prophylaxis |
| title_fullStr | Acquired Coagulopathy and Hemorrhage Secondary to Subcutaneous Heparin Prophylaxis |
| title_full_unstemmed | Acquired Coagulopathy and Hemorrhage Secondary to Subcutaneous Heparin Prophylaxis |
| title_short | Acquired Coagulopathy and Hemorrhage Secondary to Subcutaneous Heparin Prophylaxis |
| title_sort | acquired coagulopathy and hemorrhage secondary to subcutaneous heparin prophylaxis |
| url | http://dx.doi.org/10.1155/2018/9501863 |
| work_keys_str_mv | AT mariasunseri acquiredcoagulopathyandhemorrhagesecondarytosubcutaneousheparinprophylaxis AT taniaahuja acquiredcoagulopathyandhemorrhagesecondarytosubcutaneousheparinprophylaxis AT tanyawilcox acquiredcoagulopathyandhemorrhagesecondarytosubcutaneousheparinprophylaxis AT davidgreen acquiredcoagulopathyandhemorrhagesecondarytosubcutaneousheparinprophylaxis |