Authors: Wang, Y.-Y.¹; Po, H. L.²

Source: Journal of Clinical Pharmacy & Therapeutics, Volume 31, Number 5, October 2006 , pp. 513-517(5)

Publisher: Wiley-Blackwell

Abstract:

Summary Objective: 

To report three cases of alopecia induced by the anticoagulant enoxaparin in cerebral venous thrombosis (CVT) patients. Case summary: 

Three female patients were treated initially with direct intrasinus urokinase, and then followed by low-molecular-weight heparin (LMWH) enoxaparin at 1 mg/kg given subcutaneously twice daily for 3 weeks. It was switched to oral anticoagulant warfarin at 5 mg daily for another 6 months. Nearly 3 weeks after the initiation of anticoagulation, all of the three patients complained of excessive hair loss with large areas of patchy, non-scarring alopecia. Hair growth returned to normal within 1 month after the completion of enoxaparin. Discussion: 

Unfractionated heparin remains the first-line treatment of CVT because of its efficacy, safety and feasibility. Alopecia has been reported as a side effect of LMWHs dalteparin and tinzaparin. The pattern of hair loss, telogen effluvium, involves the induction of the hair follicle into a resting phase without apparent pathologic implication. In addition, this article also reviewed other medications taken by the patients that are possibly associated with hair loss. Conclusion: 

From the review of literature, there is no report of alopecia caused by urokinase. Using the Naranjo ADR Probability Scale, a score of 6 suggests that enoxaparin was the probable cause of alopecia in our three patients. This report introduces evidence of alopecia as a probable side effect of enoxaparin, but stresses the efficacy and safety of LMWH. As this is not a life-threatening disorder, we hope to increase the awareness of pharmacists and clinicians to this relatively rare but important side effect.

Keywords: alopecia; cerebral venous thrombosis; enoxaparin; low-molecular-weight heparin; warfarin

Document Type: Case report

DOI: http://dx.doi.org/10.1111/j.1365-2710.2006.00769.x

Affiliations: 1: Section Chief of Clinical Pharmacy, Department of Pharmacy, Mackay Memorial Hospital, Taipei, Taiwan, Adjunct lecturer, Department of Pharmacy, Taipei Medical University, Taipei, Taiwan 2: Senior Physician, Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan

Publication date: 2006-10-01

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