Bullous Haemorrhagic Dermatosis: A Benign Rare Cutaneous Complication of Low Molecular Weight Heparin

Abstract

Enoxaparin-mediated bullous hemorrhagic dermatosis (BHD) is a rare side effect that occurs during enoxaparin prophylaxis for multiple thromboembolic events. We describe a case of a 74-year-old woman with various comorbidities who developed BHD after receiving subcutaneous enoxaparin at a different site. The diagnosis of BHD was confirmed by histopathological examination. Bullae development gradually disappeared after the patient's enoxaparin treatment was stopped, and apixaban, a novel oral anticoagulant, was administered. Skin necrosis, pruritus, maculopapular rash, eczematous dermatitis, and bullous hemorrhagic dermatosis are some of the most common cutaneous side effects of enoxaparin. A relatively uncommon and benign side effect of enoxaparin, which is an under-recognized consequence of low-molecular-weight heparin, is hemorrhagic bullae dermatosis at a place other than the administration site.   Since these cutaneous reactions can occur at any time, regardless of the duration of anticoagulation therapy, careful monitoring is required during heparin administration.