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Heparin necrosis
Other Resources UpToDate PubMed

Heparin necrosis

Contributors: Art Papier MD, William Van Stoecker MD, Michael D. Tharp MD, Neil Shear MD
Other Resources UpToDate PubMed


The subcutaneous administration of heparin can induce a hypercoagulable state, resulting in intravascular thrombosis, infarction, and resultant skin necrosis. This usually occurs in diabetic women on high dose antibiotics, but unlike Coumadin necrosis (warfarin necrosis), heparin necrosis happens in men with relative frequency. Lethal thromboembolism has been reported. Hypersensitivity reactions to heparin can occur that are unrelated to the skin necrosis.


D68.32 – Hemorrhagic disorder due to extrinsic circulating anticoagulants

293334006 – Heparin adverse reaction

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Warfarin necrosis
  • Purpura fulminans
  • Disseminated intravascular coagulation (DIC)
  • Cryoglobulinemia
  • Cryofibrinogenemia
  • Ecthyma gangrenosum
  • Calciphylaxis
  • Necrotizing fasciitis
  • Cocaine levamisole toxicity

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Updated:12/28/2017
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Heparin necrosis
A medical illustration showing key findings of Heparin necrosis : Abdomen, Erythema, Eschar, heparin group, Painful skin lesions, Thighs
Clinical image of Heparin necrosis - imageId=88284. Click to open in gallery.  caption: 'Angulated ulcers with overlying thick eschars and surrounding yellow slough on the thighs.'
Angulated ulcers with overlying thick eschars and surrounding yellow slough on the thighs.
Copyright © 2024 VisualDx®. All rights reserved.