Association of heparin‐induced skin lesions, intracutaneous tests, and heparin‐induced IgG

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Abstract
Background: Cutaneous heparin‐induced allergic reactions to subcutaneous heparin may begin 2–5 days after administration. The relation of the delayed‐type hypersensitivity and a systemic immunologic response is controversial. The present investigation aimed to analyze the occurrence of thromboembolic complication, pathologic heparin‐induced platelet activation (HIPA), and the presence of circulating heparin‐induced IgG in patients with heparin‐induced skin reactions. Methods: Intracutaneous tests, HIPA assay, and heparin‐heparin IgG antibodies were performed in nine patients with heparin‐induced skin lesions. Results: Six of eight patients showed positive intracutaneous tests to heparin and to four low‐molecular‐weight heparins. Three of six heparin‐positive patients presented hypersensitivity to a heparinoid, too. Two of three patients had a positive HIPA test and elevated heparin‐induced IgG antibodies. Both patients developed complications presenting as heparin‐induced skin necrosis or arterial thrombosis. Two of nine patients were treated with danaparoid, 4/9 patients received r‐hirudin, and 1/9 received oral coumarin. In 2/9 patients, anticoagulant therapy was stopped, but these patients will receive r‐hirudin if indicated. Conclusions: On the basis of the coincidence of local and systemic hyperreactivity to heparin and danaparoid, patients with heparin‐induced skin lesions should receive r‐hirudin, a nonheparin compound, for anticoagulant treatment.