Can long-term treatment with Fragmin, low-molecular-weight heparin, cause hair loss?/nA 75-year-old

Fråga: Can long-term treatment with Fragmin, low-molecular-weight heparin, cause hair loss? A 75-year-old woman is being treated with Fragmin 7500E per day since January 1993 for prevention of lung embolism. She has had generalised hair loss for one year.

Sammanfattning: Hair loss is a known side-effect to heparin. Three cases of alopecia during treatment of low-molecular-weight heparin have been reported to WHO. No documentation has been found in the literature concerning low-molecular-weight heparin and hair loss.

Svar: Fragmin (dalteparin), low-molecular-weight heparin, was introduced on the Swedish market in 1988. Although hair loss is a known adverse-effect to heparin treatment it is not mentioned in review-articles or handbooks during treatment with this new low-molecular-weight heparin drug.

Transient hair loss can bee seen during treatment with heparin, usually occurring 3-20 weeks after initiation of the therapy. About every fifth patient develops a clinically evident and physiologically distributed diffuse alopecia. The extent of alopecia does not depend on the length of anticoagulant-therapy and is clearly related to the tissue levels of the drugs, even if they are only of short duration. Discontinuation of therapy is followed by a regrowth of hair (1).

No case of hair loss has been reported to SADRAC, Swedish Adverse Drug Reactions Advisory Committee, during treatment with heparin or low-molecular-weight heparin. WHO has received four cases of alopecia in connection to low-molecular-weight heparin.

We recommend this case to be reported to the Regional Centre of the SADRAC.