This review highlights the clinical importance of recognizing anticoagulant-induced skin reactions, particularly rare but severe skin necrosis, and notes the potential future role of newer direct thrombin and Factor Xa inhibitors.
Clinicians should maintain vigilance for anticoagulant skin necrosis to limit morbidity; review leaves comparative risk with newer agents open.
Cutaneous reactions have been reported during anticoagulant therapy with coumarin derivatives, unfractionated and low molecular weight heparins, heparinoids, danaparoid and hirudins. Anticoagulant-induced skin reactions vary from local allergic manifestations to skin necrosis. In patients with allergic reactions, diagnosis and crossreactions between anticoagulants can be confirmed by intracutaneous testing. Coumarin- and heparin-induced skin necrosis are rare, but are important side effects due to their high morbidity and occasional mortality. Cutaneous tests are contraindicated in these patients. In the future, anticoagulant strategies may include direct synthetic thrombin inhibitors (argatroban and melagatran/ximelagatran) and the Factor Xa inhibitor, pentasaccharide (fondaparinux).
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Jörg et al. (2002) studied this question.
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