Dabigatran in the Treatment of Warfarin-Induced Skin Necrosis: A New Hope

Abstract

Warfarin-induced skin necrosis is an infrequent and well-recognized complication of warfarin treatment. The incidence was estimated between 0.01% and 0.1% whereas a paradoxal prothrombotic state that arises from warfarin therapy seems to be responsible for this life-threatening disease. To the best of our knowledge we present the first case of an old woman diagnosed with warfarin-induced skin necrosis, in whom novel oral anticoagulants and extensive surgical debridement were combined safely with excellent results.

Adverse Drug Reactions and Cutaneous Manifestations Associated With Anticoagulation

“…Management involves warfarin cessation and switching to another anticoagulant such as the thrombin inhibitor, dabigatran. 35 In many cases, surgical intervention involving debridement, skin grafting, or amputation is also required. 34…”

“…Management involves warfarin cessation and switching to another anticoagulant such as the thrombin inhibitor, dabigatran. 35 In many cases, surgical intervention involving debridement, skin grafting, or amputation is also required. 34 Several predisposing risk factors for WISN have emerged that may increase one's index of suspicion: (a) a high warfarin loading dose (>10 mg), 36 (b) female sex and obesity, 4,5,34 and (c) patients with a thrombophilia such as PC or PS deficiency, 37 FV Leiden gene mutation, or lupus anticoagulant.…”

Warfarin-induced skin necrosis: a rare condition

“… 3 , 21 For patients with WISN who require long term anticoagulation it may be advisable to switch from Warfarin to a Non-Vitamin K Antagonist such as dabigatran and rivaroxaban where available. 22 …”

Breast necrosis in a chronic user of warfarin

“…It consists in the administration of low-molecular weight heparin doses enough for full anticoagulation, oral anticoagulant suspension, administration of fresh plasma and vitamin K, thus restoring proteins C and S through hepatic production stimulation 29 . The use of new oral anticoagulants with different action mechanism, such as direct thrombin inhibitors of the Xa factor, is also advocated 30 . Currently, despite proper treatment, more than half of the patients will require surgical debridement, amputation or total mastectomy [19][20][21][22]24,26,29 .…”