[Cholesterol crystal embolism during treatment with low-molecular-weight heparin].

BACKGROUND: Cholesterol crystal embolism is often an iatrogenic complication in ulcerated atherosclerosis of the aorta. CASE REPORTS: Two cases of multi-organ embolism of cholesterol crystals were histologically proven in patients treated with low-molecular-weight heparin. Both patients had acute renal failure, hypertension with acute pulmonary edema, skin necrosis and ischemia of the digestive tract. Outcome was favorable after discontinuing anticoagulants, symptomatic treatment, definitive hemodialysis and low-dose corticosteroids. DISCUSSION: These two cases are the first reported in the literature of cholesterol crystal embolism occurring during prophylactic treatment with low-molecular-weight heparin. They demonstrate that there is a risk of severe cholesterol embolism in high-risk patients after administration of low-molecular-weight heparin as for non-fractionated heparin, fibrinolytics, arteriography and cardiovascular surgery. Low-molecular-weight heparin thus should not be used in patients with a diagnosis of cholesterol crystal embolism.