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Table 1 Summary of cases (n = 91), part I, part II, part III

From: Bullous hemorrhagic dermatosis is an under-recognized side effect of full dose low-molecular weight heparin: a case report and review of the literature

References

Age

Gender

Agent

Days to lesion

Location

Intervention

Days to resolution

Part I

 [1]

62

F

Enoxaparin

Unknown

Buttock

AC changed to warfarin

14

 [1]

32

M

Enoxaparin

14

Lower extremities

AC discontinued

7

 [2]

75

M

Dalteparin

5

Hands and groin

AC changed to coumadin, died of IC 14 days later

Death

 [2]

82

F

Tinzaparin

6

Extremities

AC discontinued

10

 [2]

64

M

Heparin Calcium

21

Forearms and ankles

AC continued

Yes, unknown

 [3]

72

F

Enoxaparin

2

Abdomen and upper extremities

AC changed to oral after planned intervention

14

 [3]

57

M

Enoxaparin

3

Abdomen and upper and lower extremities

Unknown

Unknown

 [4]

88

M

Enoxaparin then warfarin

14

Left arm and ankle

AC discontinued

14

 [5]

51

Unknown

Enoxaparin then tinzaparin

2

Upper and lower extremities, abdomen

AC discontinued

Unknown

 [6]

86

M

Enoxaparin

1

Trunk, extremities

AC continued

30

 [6]

87

M

Enoxaparin

5

Limbs and hands

AC continued

21

 [6]

73

F

Bemiparin then Enoxaparin

1

Lower extremities

Changed to rivaroxaban, died 10 days later

Death

 [6]

72

M

Bemiparin

30

Trunk, legs

AC continued

21

 [6]

82

M

Enoxaparin

3

Arms

AC continued

21

 [7]

68

M

Enoxaparin

8

Hand, neck, and face

Unknown

14

 [7]

78

M

Enoxaparin

10

Knees and forearm

AC continued

14

 [8]

85

M

Enoxaparin

3

Torso and legs

AC discontinued

Unknown

 [9]

73

M

Enoxaparin

14

Upper extremities

AC continued

14

 [10]

77

M

Enoxaparin

3

Trunk, right hand

AC discontinued

2

 [10]

94

M

Tinzaparin

15

Trunk, limbs

AC discontinued

10

 [11]

59

F

Enoxaparin

30

Dorsal hand

AC continued

4

 [12]

68

M

Enoxaparin

1

Feet, leg, neck, hands dorsum

AC discontinued

Unknown

 [12]

77

M

Enoxaparin

8

Dorsum of feet, dorsum of hands

AC discontinued

Unknown

 [13]

88

F

Enoxaparin

5

Legs

AC changed to warfarin

Unknown

 [14]

87

F

Enoxaparin

10

Knees, forearms, elbows

Unknown

14

 [15]

71

M

Enoxaparin

2

Abdomen

AC discontinued

7

 [16]

90

M

Enoxaparin

8

Left arm and ankle

AC continued

14

 [17]

73

M

Enoxaparin

6

Left palm

AC continued

14

Part II

 [18]

63

M

Enoxaparin

12

Lower extremities

AC continued

3

 [18]

74

M

Enoxaparin

13

Lower extremities

AC continued

3

 [19]

83

M

Warfarin + UFH

5

Arms, flank, thighs

Heparin discontinued

Yes, unknown

 [20]

77

M

Enoxaparin

5

Unknown

Changed to dabigatran

14

 [21]

82

F

Warfarin

10

Extremities

Changed to enoxaparin

Worsening lesions, resolved after all AC stopped

 [22]

90

M

Enoxaparin

8

Ankle and wrist

AC continued

14

 [22]

65

M

Enoxaparin

9

Lower and upper extremities

Changed to tinzaparin as lesions persisted for 6 weeks on enoxaparin

14

 [22]

64

M

Enoxaparin

7

Lower and upper extremities

AC continued

21

 [22]

89

M

Enoxaparin

10

Lower and upper extremities scalp and back

AC discontinued

21

 [22]

74

M

Enoxaparin

20

Hand and leg

AC discontinued

14

 [23]

71

M

Enoxaparin

14

Forearms, hands, knees

AC continued

Persisting lesions for 6 months, resolved after AC stopped

 [24]

64

M

Enoxaparin

5

Arms and hands

Dose reduced

14

 [25]

74

M

Enoxaparin

5

Upper and lower extremities, abdomen

AC discontinued

7

 [26]

52

M

Enoxaparin

7

Lower and upper extremities

AC continued

3

 [27]

77

F

Enoxaparin

15

Limbs

AC continued

14

 [28]

77

F

Enoxaparin

5

Hands and shins

AC continued, fatal ICH 4 weeks later

12

 [29]

72

M

Enoxaparin

7

Arm and legs

AC changed to UFH

7

 [30]

59

F

Enoxaparin

270

Legs

AC changed to fondaparinux then rivaroxaban

Unknown

 [30]

51

F

Fondaparinux

Unknown

Legs

AC changed to rivaroxaban

3

 [31]

75

F

Enoxaparin

3

Arms, hands, feet

AC held, lesions resolved, AC restarted and lesions re-appeared, improved with steroids, patient had past history of bullous pemphigoid

28

Part III

 [32]

60

M

UFH

5

Limbs and trunk

AC continued

Unknown

 [32]

68

F

UFH then enoxaparin

7

Abdomen, hands, feet

AC changed to rivaroxaban

21

 [32]

64

M

Enoxaparin, warfarin

9

Lower and upper extremities

AC discontinued

30

 [32]

38

F

UFH

7

Chest and ankle

AC discontinued

7

 [32]

72

F

Enoxaparin

2

Forearm

AC discontinued

2

 Ref. [33];

Case series of 37 cases, 1985–2015

77.4

M 20

F 17

LMWH

Fondaparinux

Sodic heparin

Calcic heparin

8.8

Limbs and trunk

AC discontinued in 34 cases

AC continued in 1 case

Unknown in 2 cases

Unknown

 Case currently reported

62

M

Enoxaparin

7

Calf and hands

AC continued with worsening lesions, after 4 months changed to apixaban

21 after change to apixaban

  1. AC anticoagulation, F female, ICH intracranial hemorrhage, LMWH low molecular weight heparin, M male, UFH unfractionated heparin