Low molecular weight heparin-induced skin necrosis in the critically ill cardiovascular patient: A case report

Necrosis cutánea inducida por heparina de bajo peso molecular en el paciente crítico cardiovascular: a propósito de un caso

Introduction: Low molecular weight heparin-induced skin necrosis is a rare but potentially serious adverse reaction observed mainly in patients under treatment with this anticoagulant. Although thrombocytopenia is a more common complication, dermal necrosis occurs in less than 0.2% of cases. Clinical case: This report describes the case of a 78-year-old male patient with a cardiovascular history, who presented extensive necrotic lesions after administration of subcutaneous heparin for thromboembolic prophylaxis. Five days after treatment, the patient developed fever, erythema and painful ecchymosis, which prompted his transfer to the intensive care unit. After identification of necrotic hemorrhagic lesions, together with mild thrombocytopenia, heparin-induced skin necrosis was suspected, and the patient underwent several washing and debridement procedures by the plastic surgery service. The evolution was favorable, achieving healing by second intention and progressive recovery of the affected areas. Conclusion: Early identification of drug-induced lesions, immediate discontinuation of heparin and a multidisciplinary approach to avoid major complications and improve clinical outcomes could generate a better prognosis in these cases.