Enoxaparin-induced skin necrosis at injection site after total knee arthroplasty

Max Haffner, BS; Nasser Heyrani, MD; John P. Meehan, MD; Mauro Giordani, MD

Arthroplasty Today (Mar 2018)

Enoxaparin-induced skin necrosis at injection site after total knee arthroplasty

Max Haffner, BS,
Nasser Heyrani, MD,
John P. Meehan, MD,
Mauro Giordani, MD

Affiliations

Max Haffner, BS: Corresponding author. 2315 Stockton Blvd, Sacramento, CA 95817, USA. Tel.: +1 916 705 0892.; Department of Orthopaedics, University of California, Sacramento, CA, USA
Nasser Heyrani, MD: Department of Orthopaedics, University of California, Sacramento, CA, USA
John P. Meehan, MD: Department of Orthopaedics, University of California, Sacramento, CA, USA
Mauro Giordani, MD: Department of Orthopaedics, University of California, Sacramento, CA, USA

Journal volume & issue: Vol. 4, no. 1
pp. 10 – 14

Abstract

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Enoxaparin is a widely used low-molecular-weight heparin for perioperative thromboembolic prophylaxis. Enoxaparin-induced skin necrosis in the setting of arthroplasty has been rarely reported in the literature with varying outcomes and management decisions. Our patient developed skin necrosis at his injection site and thrombocytopenia 10 days following left total knee arthroplasty surgery and after receiving subcutaneous Lovenox injections postoperatively. The patient was started on an alternative anticoagulation based on a high suspicion for heparin-induced thrombocytopenia and the wound was monitored without surgical debridement. Our case highlights the key clinical management decisions when facing this potentially life-threatening adverse reaction. Keywords: Lovenox, Enoxaparin, Skin necrosis, Adverse reaction, Arthroplasty

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

About the journal