{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T16:40:57Z","timestamp":1781196057918,"version":"3.54.1"},"reference-count":12,"publisher":"PAGEPress Publications","license":[{"start":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T00:00:00Z","timestamp":1697414400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dermatol Reports"],"abstract":"<jats:p>Heparin-induced thrombocytopenia is the most clinically relevant non-haemorrhagic complication of heparin and is characterised by the presence of anti-PF4\/heparin-IgG antibodies. The circulating PF4\/heparin-IgG immune complex binds to platelets via their FcyIIa receptors, activating them and promoting their aggregation, with consequent platelet consumption, thrombocytopenia and thrombotic phenomena. Despite thrombocytopenia, this condition is not typically associated with bleeding complications. Instead, thrombosis is the most serious complication of Heparin-induced thrombocytopenia, contributing to increased morbidity and mortality. Thrombotic events can be venous and arterial, such as deep vein thrombosis, pulmonary embolism, myocardial infarction, and thrombotic stroke. Skin necrosis at the site of heparin injections is a rare but well-described manifestation of Heparin-induced thrombocytopenia. We report a case of Heparin-induced thrombocytopenia presented as skin necrosis, highlighting the importance of recognising this potentially fatal condition and the need for an immediate cessation of all sources of heparin and its replacement by other anticoagulants.<\/jats:p>","DOI":"10.4081\/dr.2023.9855","type":"journal-article","created":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T13:24:07Z","timestamp":1697462647000},"source":"Crossref","is-referenced-by-count":1,"title":["Heparin-induced thrombocytopenia: a rare presentation with skin necrosis"],"prefix":"10.4081","author":[{"given":"Filipa","family":"David","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Catarina","family":"Trigo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Ribeiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Cancela","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2023,10,16]]},"reference":[{"key":"13069","doi-asserted-by":"crossref","unstructured":"Ahmed I, Majeed A, Powell R. Heparin induced thrombocytopenia: diagnosis and management update. Postgrad Med J. 2007;83(983):575\u201382.","DOI":"10.1136\/pgmj.2007.059188"},{"key":"13070","doi-asserted-by":"crossref","unstructured":"Hogan M, Berger J. Heparin-induced thrombocytopenia (HIT): review of incidence, diagnosis, and management. Vascular Medicine. 2020;25(2):160-73.","DOI":"10.1177\/1358863X19898253"},{"key":"13071","doi-asserted-by":"crossref","unstructured":"Arepally G. Heparin-induced thrombocytopenia. Blood. 2017;129(21):2864-72.","DOI":"10.1182\/blood-2016-11-709873"},{"key":"13072","doi-asserted-by":"crossref","unstructured":"Handschin A, Trentz O, Kock H, et al. Low molecular weight heparin-induced skin necrosis- a systemic review. Langenbecks Arch Surg. 2005;390:249-54.","DOI":"10.1007\/s00423-004-0522-7"},{"key":"13073","doi-asserted-by":"crossref","unstructured":"Tietge U, Schmidt H, J\u00e4ckel C, et al. LMWH-induced skin necrosis occurring distant from injection sites and without thrombopenia. J Intern Med. 1998;243:313\u201315.","DOI":"10.1046\/j.1365-2796.1998.00304.x"},{"key":"13074","doi-asserted-by":"crossref","unstructured":"White P, Sadd J, Nensel R. Thrombotic complications of heparin therapy: including six cases of heparin--induced skin necrosis. Ann Surg. 1979;190(5):595-608.","DOI":"10.1097\/00000658-197911000-00007"},{"key":"13075","doi-asserted-by":"crossref","unstructured":"Warkentin T. Heparin-induced skin lesions. Br J Haematol. 1996;92(2):494-97.","DOI":"10.1046\/j.1365-2141.1996.d01-1481.x"},{"key":"13076","doi-asserted-by":"crossref","unstructured":"Warkentin T, Roberts R, Hirsh J, et al. Heparin-induced skin lesions and other unusual sequelae of the heparin-induced thrombocytopenia syndrome: a nested cohort study. Chest. 2005;127(5):1857-61.","DOI":"10.1378\/chest.127.5.1857"},{"key":"13077","doi-asserted-by":"crossref","unstructured":"Katsourakis A, Noussios G, Kapoutsis G, et al. Low molecular weight heparin-induced skin necrosis: a case report. Case Rep Med. 2011;2011:857391.","DOI":"10.1155\/2011\/857391"},{"key":"13078","doi-asserted-by":"crossref","unstructured":"Bertrand P, Perbet S, Sapin A, et al. Heparin-induced skin necrosis: HIT-2 without thrombocytopenia. Intensive Care Med. 2011;37:172\u201373.","DOI":"10.1007\/s00134-010-2027-x"},{"key":"13079","doi-asserted-by":"crossref","unstructured":"Warkentin T, Pai M, Linkins L. Direct oral anticoagulants for treatment of HIT: update of Hamilton experience and literature review. Blood. 2017;130(9):1104-113.","DOI":"10.1182\/blood-2017-04-778993"},{"key":"13080","doi-asserted-by":"crossref","unstructured":"Cuker A, Arepally G, Chong B, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Advances. 2018;2(22):3360-92.","DOI":"10.1182\/bloodadvances.2018024489"}],"container-title":["Dermatology Reports"],"original-title":[],"link":[{"URL":"https:\/\/www.pagepress.org\/journals\/index.php\/dr\/article\/download\/9855\/9232","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.pagepress.org\/journals\/index.php\/dr\/article\/download\/9855\/9232","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T13:24:13Z","timestamp":1697462653000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.pagepress.org\/journals\/index.php\/dr\/article\/view\/9855"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,16]]},"references-count":12,"URL":"https:\/\/doi.org\/10.4081\/dr.2023.9855","relation":{},"ISSN":["2036-7406","2036-7392"],"issn-type":[{"value":"2036-7406","type":"electronic"},{"value":"2036-7392","type":"print"}],"subject":[],"published":{"date-parts":[[2023,10,16]]}}}