THE ROLE OF HEPARIN IN THE PREVENTION OF EXTREMITY AND DIGIT NECROSIS IN MENINGOCOCCAL PURPURA FULMINANS

In order to gather data regarding the utility of heparin therapy in limiting digit and extremity necrosis resulting from meningococcal purpura fulminans in children, we reviewed the charts of 24 pediatric patients with PF associated with meningococcal disease. Our study population was comprised of the 13 patients who survived more than 2 days. Clinical and outcome data were compared between the group of patients who received therapeutic heparin treatment in the initial 72 hours (greater than or equal to 50 units/kg bolus followed by an infusion, three patients) and the group who did not (10 patients). Demographic and initial clinical and laboratory findings were similar between groups (P > 0.15). When the two groups were compared for dermatologic and orthopedic sequelae, the mean number of digits (6.3 vs. 11.1; P = 0.35) and extremities (1.7 vs. 3.0; P = 0.17) with necrosis was less in those patients who received therapeutic doses of heparin, although the differences were not statistically significant. When only those patients on whom diffuse purpura were noted on admission were compared, these differences were greater. This small, retrospective series suggests that heparin therapy may limit digit and extremity necrosis when used early and in therapeutic doses in meningococcal purpura fulminans. Therefore, a larger, prospective controlled trial is warranted.