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Enoxaparin‐induced alopecia in patients with cerebral venous thrombosis
Author(s) -
Wang Y.Y.,
Po H. L.
Publication year - 2006
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/j.1365-2710.2006.00769.x
Subject(s) - medicine , low molecular weight heparin , hair loss , anticoagulant , heparin , thrombosis , warfarin , urokinase , venous thrombosis , surgery , side effect (computer science) , enoxaparin sodium , dermatology , anesthesia , atrial fibrillation , computer science , programming language
Summary Objective: To report three cases of alopecia induced by the anticoagulant enoxaparin in cerebral venous thrombosis (CVT) patients. Case summary: Three female patients were treated initially with direct intrasinus urokinase, and then followed by low‐molecular‐weight heparin (LMWH) enoxaparin at 1 mg/kg given subcutaneously twice daily for 3 weeks. It was switched to oral anticoagulant warfarin at 5 mg daily for another 6 months. Nearly 3 weeks after the initiation of anticoagulation, all of the three patients complained of excessive hair loss with large areas of patchy, non‐scarring alopecia. Hair growth returned to normal within 1 month after the completion of enoxaparin. Discussion: Unfractionated heparin remains the first‐line treatment of CVT because of its efficacy, safety and feasibility. Alopecia has been reported as a side effect of LMWHs dalteparin and tinzaparin. The pattern of hair loss, telogen effluvium, involves the induction of the hair follicle into a resting phase without apparent pathologic implication. In addition, this article also reviewed other medications taken by the patients that are possibly associated with hair loss. Conclusion: From the review of literature, there is no report of alopecia caused by urokinase. Using the Naranjo ADR Probability Scale, a score of 6 suggests that enoxaparin was the probable cause of alopecia in our three patients. This report introduces evidence of alopecia as a probable side effect of enoxaparin, but stresses the efficacy and safety of LMWH. As this is not a life‐threatening disorder, we hope to increase the awareness of pharmacists and clinicians to this relatively rare but important side effect.