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Delayed‐type hypersensitivity skin reactions due to heparins and heparinoids. Tolerance of recombinant hirudins and of the new synthetic anticoagulant fondaparinux
Author(s) -
Koch Patrick
Publication year - 2003
Publication title -
contact dermatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.524
H-Index - 96
eISSN - 1600-0536
pISSN - 0105-1873
DOI - 10.1111/j.0105-1873.2003.0255.x
Subject(s) - fondaparinux , heparinoid , anticoagulant , medicine , heparin , allergy , delayed hypersensitivity , dermatology , pharmacology , immunology , surgery , antigen , thrombosis , venous thromboembolism
Eczema‐like, infiltrated plaques at subcutaneous heparin‐injection sites are well‐documented side effects of these anticoagulants. They are due to delayed‐type hypersensitivity. In 4 patients, patch, intradermal and subcutaneous tests were performed with a panel of unfractionated heparins (UFHs), low‐molecular‐weight heparins (LMWHs), heparinoids, recombinant hirudins and a new synthetic pentasaccharide anticoagulant fondaparinux sodium, to find safe alternatives. 3 patients were sensitized to all the UFHs and LMWHs. The LMWH tinzaparin sodium and the heparinoid pentosan polysulfate were found to be a possible substitute in patient no. 1 and 2, respectively. The recombinant hirudins and fondaparinux sodium were tolerated without any side effects in all patients tested. Fondaparinux is a synthetic copy of a pentasaccharide sequence in the heparin molecule. It is the first in a new class of antithrombotic agents. Our study suggests that it is a new safe alternative in patients with eczema‐like, infiltrated plaques at subcutaneous heparin‐injection sites.