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首页> 外文期刊>Experimental Hematology Oncology >Bullous hemorrhagic dermatosis is an under-recognized side effect of full dose low-molecular weight heparin: a case report and review of the literature
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Bullous hemorrhagic dermatosis is an under-recognized side effect of full dose low-molecular weight heparin: a case report and review of the literature

机译：大疱性出血性皮肤病是全剂量低分子量肝素的公认副作用：一个案例报告和对文献的审查

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Bullous hemorrhagic dermatosis (BHD) is a systemic side-effect of low molecular weight heparin, characterized by multiple intra-epidermal hemorrhages distant from the site of injection. There have been several small case series and literature reviews on BHD, but none have captured a complete set of reported patients. We sought to describe a case of BHD with late diagnosis and completely summarize the existing English and Spanish literature with searches of Pubmed, Scopus, Ovid Embase and Ovid Medline. After narrowing to 33 relevant reports, we describe 90 reported cases worldwide from 2004 to 2017, in addition to a new case from our institution as a means of comparison. We found that BHD was common in elderly men (mean age 72?±?12; male:female, 1.9:1) and typically occurred within 7?days of administration of anticoagulation (median 7?days?±?6.4) usually with enoxaparin use (66% of cases). Lesions occurred primarily on the extremities only (67.9% of cases). Coagulation testing was most often normal before administration, and the majority of patients had coagulation testing in therapeutic range during treatment. Most practitioners stopped anticoagulation if continued therapeutic intervention was no longer required (57% of cases), or changed therapy to another anticoagulation if continued treatment was required (14.3% of cases). Therapy was continued outright in 23% of patients. The lesions usually resolved within 2?weeks (mean days, 13.0?±?7.4). There was no difference in time to resolution between patients who continued the culprit anticoagulant or changed to a different anticoagulant, and those who discontinued anticoagulation altogether (13.9?days vs. 12.1, p?=?0.49). Four deaths have been reported in this clinical context, two specified as intracranial hemorrhage. These deaths were unrelated to the occurrence of BHD. Continuation of low-molecular weight heparins appeared to be safe in patients with BHD.
机译：大疱性出血性皮肤病（BHD）是低分子量肝素的全身副作用，其特征在于从注射部位远处的多重表皮内出血。关于BHD有几种小案系列和文学评论，但没有人捕获了一套完整的报告患者。我们试图描述患有晚期诊断的BHD的案例，并完全总结了现有的英语和西班牙文学，搜索了PubMed，Scopus，Ovid Embase和Ovid Medline。在缩小到33个相关报告后，除了从我们的机构作为比较手段之外，我们还向2017年描述了90个报告的全球案件。我们发现BHD在老年人常见（平均年龄72？±12;男性：女性，1.9：1），通常发生在7？天时间的抗凝血（中位数7？天？±6.4）内发生使用（66％的病例）。病变主要发生在四肢（案件的67.9％）。凝血检测在给药前最常是正常的，并且大多数患者在治疗过程中凝血试验在治疗范围内。如果不再需要持续的治疗干预（案件的57％），大多数从业者都停止了抗菌，或者如果需要持续治疗（14.3％的病例），则将治疗转变为另一种抗凝症在23％的患者中，治疗均直接持续。病变通常在2？周内解决（平均，13.0？±7.4）。在继续罪魁祸首抗凝血或改变为不同的抗凝血剂的患者之间的患者之间没有差异，以及完全停止抗凝的人（13.9？天与12.1，P？= 0.49）。在该临床背景下报告了四种死亡，其中两种被指定为颅内出血。这些死亡与BHD的发生无关。延续低分子量肝素似乎在BHD患者中是安全的。

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