Cutaneous and Subcutaneous Necrosis as a Complication of Coumarin-Congener Therapy

Kahn, Sidney; Hd, Stern; Ga, Rhodes

doi:10.1097/00006534-197108000-00008

Cited by 21 publications

(12 citation statements)

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“…Scarification and intracutaneous skin challenge produce no reaction [3,6], Coumadin treatment induces several kinds of skin lesions [2], This study has brought evidence of an immunological involvement in a case of nonpruritic purpuric skin eruption. Of interest is the fact that the histolog ical features of coumadin-induced dermal gangrene [16][17][18][19], which is the most common dermatological complication, are consistent with leukocy toclastic vasculitis [6,20,21 ], a finding which suggests an immunological reaction.…”

Section: Commentmentioning

confidence: 99%

Dermal Vasculitis due to Coumadin Hypersensitivity

et al. 1982

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A 65-year-old patient developed nonpruritic purpuric skin eruptions following 10 days of coumadin treatment. Skin biopsy revealed vasculitis and immunofluorescent studies demonstrated the presence of IgM and C3 deposits in the walls of the affected blood vessels. Rechallenge with coumadin was followed by reappearance of the skin eruptions. Indirect mast cell degranulation test and migration inhibiting factor test were positive in the presence of coumadin. These findings strongly suggest that the skin lesions were induced by an immunologic reaction to warfarin.

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Section: Commentmentioning

confidence: 99%

Dermal Vasculitis due to Coumadin Hypersensitivity

et al. 1982

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“…There is limited information regard ing the effect of restarting oral anticoagulants in patients with a past history of warfarininduced skin necrosis. Anecdotal reports in the literature have documented both un eventful clinical courses [20][21][22][23][24] and recur rences of skin necrosis with restarting warfa rin therapy [18, [25][26][27][28]. In the latter group of 5 patients, recurrences occurred shortly fol lowing the reinstatement of warfarin in 2 patients [18,25] in association with an in crease in the warfarin dosage in 1 patient [26], and with a deterioration in liver func tion in 2 other cases [27,28].…”

Section: Discussionmentioning

confidence: 99%

Warfarin-Induced Skin Necrosis in 2 Patients with Protein S Deficiency: Successful Reinstatement of Warfarin Therapy

Anderson

Brill-Edwards²,

Walker³

1992

Pathophysiol Haemos Thromb

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Warfarin-induced skin necrosis is a rare but serious complication of oral anticoagulant therapy. This condition has been associated with protein C deficiency but only rarely reported in patients with a deficiency of protein S. We have managed 2 patients with a history of warfarin-induced skin necrosis who were diagnosed as being protein-S-deficient. Since both patients were candidates for long-term anticoagulant therapy we elected to reintroduce warfarin using a regimen designed to minimize the risk of recurrent skin necrosis. While they were therapeutically anticoagulated with heparin, warfarin was started at 1 mg/day and the dose was increased gradually. Heparin was not discontinued until the prothrombin times were in the therapeutic range for at least 72 h. Both patients tolerated the reinstitution of warfarin without difficulty and they have now been followed for over 2 years on oral anticoagulants without complication.

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“…According to several authors [9,II,15] the vasculitis phenomenon occurred between the age of 12 and 93 years and in 92% of cases is more prevalent in obese women over 50 years of age. Generally the skin manifes tations appear between the 3rd and the 10th day of anticoagulant treatment but may occur later.…”

Section: Discussionmentioning

confidence: 99%

“…Similar findings have been reported by Kahn el at. [9], Koch-Weser [10], Lewinski el al. [12], and Turcotte el al.…”

Section: Discussionmentioning

confidence: 99%

Skin Petechiae and Ecchymoses (Vasculitis) Due to Anticoagulant Therapy

Stavorovsky¹,

Lichtenstein²,

Nissim³

1979

Dermatology

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The appearance of petechiae and ecchymoses following anticoagulant and fibrinolytic therapy is an unusual and rare complication. The mechanism of the vasculitis is obscure but may be related to a chemical vasotoxic reaction. During anticoagulant and fibrinolytic therapy, 6 patients developed petechiae and ecchymoses which was accompanied by pain and fever. There were no disturbances of blood clotting factors. In spite of the varied action of the different anticoagulants and fibrinolytic drugs, the clinical course and the histological examination demonstrated a similar identical vasculitis.

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Cutaneous and Subcutaneous Necrosis as a Complication of Coumarin-Congener Therapy

Cited by 21 publications

References 0 publications

Dermal Vasculitis due to Coumadin Hypersensitivity

Dermal Vasculitis due to Coumadin Hypersensitivity

Warfarin-Induced Skin Necrosis in 2 Patients with Protein S Deficiency: Successful Reinstatement of Warfarin Therapy

Skin Petechiae and Ecchymoses (Vasculitis) Due to Anticoagulant Therapy

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