Low Molecular Weight Heparin as Cause of Liver Injury: Case Report and Literature Review

OBJECTIVE To explore the adverse reactions of liver system induced by low molecular weight heparin(LMWH). METHODS One case of liver injury induced by LMWH was reported. Relevant literatures at home and abroad were retrieved and analyzed statistically. RESULTS A total of 15 related reports were retrieved and 23 cases were identified in the study. There were 12 males and 11 females patients with the age ranged from 26 to 75 years(mean age 54 years). The primary diseases were pulmonary embolism and deep vein thrombosis (pulmonary embolism was more than deep vein thrombosis). The adverse reactions induced by the liver system were mainly hepatocellular injury type(n=7), mixed pattern of injury(n=7), cholestatic injury(n=1) and unknown(n=9). The average duration from an initiation of LMWH treatment to an induction of adverse reactions of liver dysfunction was 1 to 33 d(mean 6 d). LMWH was then discontinued for 10 cases, 11 cases were stopped and given symptomatic treatment, and 2 patients did not receive any treatment. Among the adverse reaction results, except for one patient whose outcome was unknown, the liver function of the remaining 22 patients improved after the discontinuation of LMWH, 11 patients were recovered, and the recovery time of one patient was unknown. The average recovery time of the remaining 10 patients was 66.5 d. CONCLUSION LMWH related liver injury is not common and reversible, and the recovery time of liver injury is long. While prescribing LMWH, clinicians and pharmacists should pay close attention to adverse reactions of liver and regularly monitor the changes of liver function parameters, in order to timely detection, diagnosis and treatment of drug-induced liver injury, to ensure the safety of patients with medication.