Abstract
Drugs with anticoagulant activity, including heparins, hirudins, coumarins, and platelet aggregation inhibitors belong to the most widely used drugs. Hypersensitivity reactions from these agents are rare. However, due to their widespread use, they may have a considerable impact on patient safety and treatment. Accurate diagnosis of potentially lifethreatening adverse events and identification of alternatives is mandatory. We review hypersensitivity reactions caused by the different groups of anticoagulant agents and discuss the pathophysiological mechanisms, diagnostic possibilities and management options. According to patients histories the most common hypersensitivity reaction is intolerance to acetylsalicylic acid (ASA). Also localized erythematous plaques, occurring to subcutaneous application of heparins are rather common. Other hypersensitivity reactions are rare but may be life-threatening, e.g. skin necrosis due to heparin-induced thrombocytopenia. Rarely anaphylactoid reactions have been observed to ASA, heparin, and hirudin. Skin and provocation tests with immediate and late readings are the most reliable diagnostic tools for heparin- or hirudininduced urticaria/anaphylaxis or heparin-induced delayed plaques. Provocation tests may be used to identify safe alternatives. In cases of necrosis from heparins or coumarins, all in vivo tests are contraindicated. Most in vitro tests are not universally available, and with the exception of platelet aggregation tests, they have a low sensitivity. In some anticoagulant-associated hypersensitivity reactions detailed allergologic investigation may help to identify safe treatment alternatives. Typically, several tests are needed, and therefore the test procedures are time consuming.
Keywords: Anticoagulants, hypersensitivity, allergy, heparins, coumarins, acetylsalicylic acid, thienopyridins
Current Pharmaceutical Design
Title: Hypersensitivity Reactions to Anticoagulant Drugs
Volume: 14 Issue: 27
Author(s): Kathrin Scherer, Dimitrios A. Tsakiris and Andreas J. Bircher
Affiliation:
Keywords: Anticoagulants, hypersensitivity, allergy, heparins, coumarins, acetylsalicylic acid, thienopyridins
Abstract: Drugs with anticoagulant activity, including heparins, hirudins, coumarins, and platelet aggregation inhibitors belong to the most widely used drugs. Hypersensitivity reactions from these agents are rare. However, due to their widespread use, they may have a considerable impact on patient safety and treatment. Accurate diagnosis of potentially lifethreatening adverse events and identification of alternatives is mandatory. We review hypersensitivity reactions caused by the different groups of anticoagulant agents and discuss the pathophysiological mechanisms, diagnostic possibilities and management options. According to patients histories the most common hypersensitivity reaction is intolerance to acetylsalicylic acid (ASA). Also localized erythematous plaques, occurring to subcutaneous application of heparins are rather common. Other hypersensitivity reactions are rare but may be life-threatening, e.g. skin necrosis due to heparin-induced thrombocytopenia. Rarely anaphylactoid reactions have been observed to ASA, heparin, and hirudin. Skin and provocation tests with immediate and late readings are the most reliable diagnostic tools for heparin- or hirudininduced urticaria/anaphylaxis or heparin-induced delayed plaques. Provocation tests may be used to identify safe alternatives. In cases of necrosis from heparins or coumarins, all in vivo tests are contraindicated. Most in vitro tests are not universally available, and with the exception of platelet aggregation tests, they have a low sensitivity. In some anticoagulant-associated hypersensitivity reactions detailed allergologic investigation may help to identify safe treatment alternatives. Typically, several tests are needed, and therefore the test procedures are time consuming.
Export Options
About this article
Cite this article as:
Scherer Kathrin, Tsakiris A. Dimitrios and Bircher J. Andreas, Hypersensitivity Reactions to Anticoagulant Drugs, Current Pharmaceutical Design 2008; 14 (27) . https://dx.doi.org/10.2174/138161208786369768
DOI https://dx.doi.org/10.2174/138161208786369768 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
A Case of Pantoprazole Anaphylaxis with Cross Reactivity to All Proton Pump Inhibitors: Finding a Safe Alternative
Current Drug Safety Peptide Metabolism and the Control of Body Fluid Homeostasis
Current Medicinal Chemistry - Cardiovascular & Hematological Agents Immunotherapy for Food Allergies in Children
Current Pharmaceutical Design Monoclonal Antibodies in Allergy; Updated Applications and Promising Trials
Recent Patents on Inflammation & Allergy Drug Discovery Novel Oral Anticoagulants for Venous Thromboembolism with Special Emphasis on Risk of Hemorrhagic Complications and Reversal Agents
Current Drug Therapy Interrelationships with Metabolic Syndrome, Obesity and Cardiovascular Risk
Current Vascular Pharmacology Action Mechanism of Antihistamines and the New Antihistamines
Current Medicinal Chemistry - Anti-Inflammatory & Anti-Allergy Agents Antivenoms for Snakebite Envenomings
Inflammation & Allergy - Drug Targets (Discontinued) 2-Methoxyestradiol as a Potential Cytostatic Drug in Gliomas?
Anti-Cancer Agents in Medicinal Chemistry Endothelin-Converting Enzyme Inhibitors
Current Enzyme Inhibition Antiepileptic Drug-Induced Hypersensitivity Syndrome Reactions
Current Drug Safety Multi-element Analyses and Chemical-physical Investigations of Food Samples
Current Nutrition & Food Science PF-04886847 (an Inhibitor of Plasma Kallikrein) Attenuates Inflammatory Mediators and Activation of Blood Coagulation in Rat Model of Lipopolysaccharide (LPS) - Induced Sepsis
Cardiovascular & Hematological Agents in Medicinal Chemistry Dipeptidyl Peptidase IV Inhibitors: A New Paradigm in Type 2 Diabetes Treatment
Current Drug Targets Management of Hypertension-Journey from Single Drug Therapy to Multitargeted Ligand Therapy: A Clinical Overview
Current Clinical Pharmacology The Dietary Paradox in Food Allergy: Yesterday's Mistakes, Today's Evidence and Lessons for Tomorrow
Current Pharmaceutical Design Seasonal Allergic Rhinitis
Recent Patents on Inflammation & Allergy Drug Discovery New Applications for Sublingual Immunotherapy in Allergy
Recent Patents on Inflammation & Allergy Drug Discovery Macrolides Allergy
Current Pharmaceutical Design Adenovirus Vectors and Subviral Particles for Protein and Peptide Delivery
Current Gene Therapy