{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T05:05:06Z","timestamp":1768280706231,"version":"3.49.0"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"vor","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Low-molecular-weight heparins (LMWHs) are widely used during pregnancy and postpartum to prevent thrombosis and are generally safe. Rarely, they can trigger delayed hypersensitivity reactions causing skin necrosis and infection. Recognizing this complication is important for timely care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 40-year-old woman developed painful necrotic patches at enoxaparin injection sites on her abdomen and arm one week after cesarean delivery. The lesions were red, tender, and associated with elevated inflammatory markers, while platelet counts were normal, excluding heparin-induced thrombocytopenia. She was diagnosed with LMWH-induced delayed hypersensitivity complicated by cellulitis. Enoxaparin was stopped, and she recovered with apixaban, intravenous antibiotics, wound care, and partial debridement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These reactions usually appear 5\u201314\u00a0days after starting LMWH and can mimic infection or thrombosis. They reflect T-cell\u2013mediated vascular injury and require clinical attention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LMWH-induced skin necrosis is rare but serious. Early recognition and switching to alternative anticoagulation are essential for favorable outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/omcr\/omaf271","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T12:57:28Z","timestamp":1762865848000},"source":"Crossref","is-referenced-by-count":1,"title":["When prophylaxis turns pathologic: a case of LMWH-induced necrosis with secondary cellulitis"],"prefix":"10.1093","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0873-8374","authenticated-orcid":false,"given":"Mohammed","family":"AbuBaha","sequence":"first","affiliation":[{"name":"Department of Medicine, An-Najah National University , Rafidia Street, Nablus P400 ,","place":["Palestine"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2333-8309","authenticated-orcid":false,"given":"Bara","family":"AbuBaha","sequence":"additional","affiliation":[{"name":"Department of Medicine, An-Najah National University , Rafidia Street, Nablus P400 ,","place":["Palestine"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5346-9973","authenticated-orcid":false,"given":"Hossam","family":"Salameh","sequence":"additional","affiliation":[{"name":"Department of Medicine, An-Najah National University , Rafidia Street, Nablus P400 ,","place":["Palestine"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4429-0590","authenticated-orcid":false,"given":"Asem","family":"Afana","sequence":"additional","affiliation":[{"name":"Department of Medicine, An-Najah National University , Rafidia Street, Nablus P400 ,","place":["Palestine"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim","family":"Abseh","sequence":"additional","affiliation":[{"name":"Department of Medicine, An-Najah National University , Rafidia Street, Nablus P400 ,","place":["Palestine"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hatem","family":"Taha","sequence":"additional","affiliation":[{"name":"Head, Department of Internal Medicine, Palestine Medical Complex , Al Ma'ahed Street, Ramallah P601 ,","place":["Palestine"]},{"name":"Faculty of Medicine and Health Sciences, An-Najah National University , Rafidia Street, Nablus P400 ,","place":["Palestine"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,12,26]]},"reference":[{"key":"2025122602500851300_ref1","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.jaci.2013.02.047","article-title":"High incidence of heparin-induced allergic delayed-type hypersensitivity reactions in pregnancy","volume":"132","author":"Schindewolf","year":"2013","journal-title":"J Allergy Clin Immunol"},{"key":"2025122602500851300_ref2","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1503\/cmaj.081729","article-title":"Incidence and causes of heparin-induced skin lesions. 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