Delayed onset low molecular weight heparin induced skin necrosis is a rare adverse event. It usually occurs at the site of injection, and typically develops within 2 weeks of starting therapy. However, in our case, we presented a 62-year-old woman who is on Hemodialysis twice a week. Her hemodialysis prescription included Enoxaparine 0.2 cc IV as anticoagulant. On her third month of regular hemodialysis, she developed skin necrosis on her right leg and left hand. The diagnosis was made clinically and by exclusion of other possible causes of skin necrosis in a chronic kidney disease patient, such as calciphylaxis. The most important aspect of management, in this case, is early recognition and withdrawal of its use, which were done in our patient.
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