Warfarin-induced skin necrosis

Warfarin-Induced Skin Necrosis Following Heparin-Induced Thrombocytopenia

“…Once the thrombocytopenia has resolved, modest doses of warfarin should be used during the transition from the direct thrombin inhibitor (5). Warfarin can induce a paradoxical hypercoagulable state in the early stages of treatment, usually within 3 to 10 days of therapy initiation, associated with inadequate overlap with heparin (3). Th e mechanism is thought to be due to a disturbance in the balance between the anticoagulant and procoagulant pathways (5).…”

“…Her platelet count at the time was 132,000/mm 3 . Examination revealed a well-demarcated ecchymotic patch with overlying hemorrhagic blisters and areas of retiform purpura on the right breast ( Figure 1a).…”

“…Her platelet count on admission was 184,000/mm 3 . After 10 days of heparin therapy, she developed bilateral lower extremity cyanosis and a decrease in platelet count to 121,000/mm 3 . HITT was suspected, and both a heparin PF4 antibody test and 14C-serotonin release assay were positive, confi rming the diagnosis.…”

Skin Necrosis Induced by Coumarin Congeners

“…4,15,18 Sites are random but usually involve areas with abundant subcutaneous tissue, such as the breast, abdomen, buttocks, and thighs. 1,4,11,15 Other sites include the arms, 11,15,25 hands, 15,25,27 feet, 3,14,15,18,26,27 extremities, 3,6,15 nose, 15 and penis. 7,16 Single lesions are most prevalent.…”

Warfarin-Induced Skin Necrosis

“…WISN is diagnosed by the history, typical lesions on exam, and exclusion of alternative diagnoses. 2 It occurs primarily in obese women. Risk factors include recent initiation of warfarin (average 3-6 days), high "loading" doses of warfarin, and hereditary protein C or S deficiency.…”