Systematic review of warfarin‐induced skin necrosis case reports and secondary analysis of factors associated with mortality

Abstract

Warfarin is one of the most commonly prescribed and used oral anticoagulants worldwide (0.5%-1.5%), it is mainly prescribed to individuals with atrial fibrillation. 1,2 Warfarin-induced skin necrosis (WSN) is a rare and severe adverse reaction, affecting between 0.01% and 0.1% of patients who take warfarin. It has a mortality rate of 15% within three months of the acute event. 3,4 Hypersensitivity to this drug is caused by a reaction to local factors such as trauma, inadequate perfusion, viral infections and hereditary or dysfunctional protein C and S. These factors cause a transient imbalance between procoagulant and anticoagulant systems producing a hypercoagulable state, and consequently, microthrombi that trigger skin necrosis. 5,6 WSN is characterised by rapidly progressive lesions that appear 3-10 days after the initiation of therapy, often affecting areas of major subcutaneous tissue, such as breasts, buttocks and abdomen. 7,8 Few studies have analysed WSN, and no study has identified the factors associated with mortality, probably because of the low incidence of this event. For this reason, we conducted a systematic review of case reports of WSN, including a Peruvian case, exploring the clinical characteristics of patients and the factors associated with mortality because of WSN-related complications.

Causal relationship between atrial fibrillation/warfarin and cutaneous melanoma: a two-sample Mendelian randomization study

“…However, it is opposed to the literature that warfarin can inhibit the proliferation of tumor cells in basic cell experiments and be beneficial to preventing the recurrence of malignant melanoma ( 15 , 29 , 30 ). Our results suggest that warfarin is a positive factor of cM, which may be related to the side effect of warfarin, which can cause skin tissue death (necrosis) ( 31 ). In patients with cM accompanied with atrial fibrillation, the skin may always tolerate the influence of warfarin to prevent thrombosis caused by atrial fibrillation, which may lead to changes in skin cells of patients with atrial fibrillation and induce cM.…”

Anticoagulation in Patients with Chronic Kidney Disease

“…1). Vitamin K hydroquinone is a cofactor for gamma carboxylase, which is essential for the post-translational modification of glutamic acid residues in molecules involved in coagulation (factors VII, IX, X, and II), anticoagulation (protein C, S, and Z), vascular calcification inhibition [9][10][11][12].…”