Warfarin-Induced Skin Necrosis Following Heparin-Induced Thrombocytopenia

Fawaz, Bilal; Candelario, Nicole; Rochet, Nicole M.; Tran, Connie; Brau, Cristina

doi:10.1080/08998280.2016.11929362

Cited by 12 publications

(6 citation statements)

References 16 publications

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“…According to another recent hypothesis, the major incidence of thrombosis in these venous sites could be related to a nonunidirectional blood flow due to body posture in this vascular district, which does not present a valvular system, with a prolonged exposure to the soluble spike protein and a high risk of binding of this protein to endothelial cells expressing ACE2 (41). These sites are different than those affected in the HIT, including adrenal hemorrhagic necrosis, limb thrombosis, disseminated intravascular coagulation, skin necrosis, deep vein thrombosis, left ventricle thrombosis, and endograft thrombosis (62)(63)(64)(65)(66)(67)(68)(69).…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Vaccine-Related Thrombosis: A Systematic Review and Exploratory Analysis

et al. 2021

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IntroductionThe World Health Organization declared the coronavirus disease 2019 (COVID-19) pandemic on March 11, 2020. Two vaccine types were developed using two different technologies: viral vectors and mRNA. Thrombosis is one of the most severe and atypical adverse effects of vaccines. This study aimed to analyze published cases of thrombosis after COVID-19 vaccinations to identify patients’ features, potential pathophysiological mechanisms, timing of appearance of the adverse events, and other critical issues.Materials and MethodsWe performed a systematic electronic search of scientific articles regarding COVID-19 vaccine-related thrombosis and its complications on the PubMed (MEDLINE) database and through manual searches. We selected 10 out of 50 articles from February 1 to May 5, 2021 and performed a descriptive analysis of the adverse events caused by the mRNA-based Pfizer and Moderna vaccines and the adenovirus-based AstraZeneca vaccine.ResultsIn the articles on the Pfizer and Moderna vaccines, the sample consisted of three male patients with age heterogeneity. The time from vaccination to admission was ≤3 days in all cases; all patients presented signs of petechiae/purpura at admission, with a low platelet count. In the studies on the AstraZeneca vaccine, the sample consisted of 58 individuals with a high age heterogeneity and a high female prevalence. Symptoms appeared around the ninth day, and headache was the most common symptom. The platelet count was below the lower limit of the normal range. All patients except one were positive for PF4 antibodies. The cerebral venous sinus was the most affected site. Death was the most prevalent outcome in all studies, except for one study in which most of the patients remained alive.DiscussionVaccine-induced thrombotic thrombocytopenia (VITT) is an unknown nosological phenomenon secondary to inoculation with the COVID-19 vaccine. Several hypotheses have been formulated regarding its physiopathological mechanism. Recent studies have assumed a mechanism that is assimilable to heparin-induced thrombocytopenia, with protagonist antibodies against the PF4–polyanion complex. Viral DNA has a negative charge and can bind to PF4, causing VITT. New experimental studies have assumed that thrombosis is related to a soluble adenoviral protein spike variant, originating from splicing events, which cause important endothelial inflammatory events, and binding to endothelial cells expressing ACE2.ConclusionFurther studies are needed to better identify VITT’s pathophysiological mechanisms and genetic, demographic, or clinical predisposition of high-risk patients, to investigate the correlation of VITT with the different vaccine types, and to test the significance of the findings.

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Section: Discussionmentioning

confidence: 99%

COVID-19 Vaccine-Related Thrombosis: A Systematic Review and Exploratory Analysis

et al. 2021

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“…The pathophysiological mechanisms for warfarin-induced skin necrosis, despite several theories, remain uncertain, although,it has been informed to be related with microvascular thrombosis, hypersensitivity to warfarin and a direct toxic effect of the drug. However, the most likely mechanism seems to be a temporary imbalance between the anticoagulant-procoagulant system, more specifically associated with a rapid decrease in C and S protein levels during initial therapy with warfarin [5]. Regarding the lesions associated with this condition, the patient first presents an erythematous rash poorly demarcated and often associated with tissue soft edemaand paresthesias, subsequently might appear petechiae progressing within hours to ecchymoses and large hemorrhagic blisters that turn into afrank necrosis.…”

Section: Discussionmentioning

confidence: 99%

Late-Onset Warfarin-Induced Skin Necrosis: A Standing Shadow

Fernandez¹

2016

JOCCT

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One of the clinical situations linked to the use of warfarin is the skin necrosisoccurring in approximately 0.01 to 0.1% of all patients receiving warfarin. Typically, lesions develop during the first days after initiation of warfarin therapy (usually around the tenth day) and are often associated with the administration of a loading dose. The pathophysiological mechanisms for warfarin-induced skin necrosis, despite several theories, remain uncertain. For the diagnosis, along with a high degree of suspicion, a rapid recognition and management is required.

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“…Stacher first reported skin necrosis due to anticoagulant therapy [12, 16]. Warfarin-induced skin necrosis almost always occurs by day 10 after therapy [17]. Since the 1950s, with the use of new biological materials, exposure to implants has increased [13].…”

Section: Reviewmentioning

confidence: 99%

Iatrogenic wounds: a common but often overlooked problem

Tian

Peng

2019

Burns &Amp; Trauma

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Iatrogenic wounds are a common but often overlooked concept. They can lead to increases in hospital stays, therapy costs, repeat surgeries, and implant removal. If not handled properly, these wounds have a very poor prognosis and will cause serious physical and psychological harm to patients, which may result in medicolegal disputes. In recent years, the incidence of iatrogenic wounds has increased because of (1) an increase in the population of older people owing to increased life expectancy, (2) the continued expansion of surgical indications, (3) an increase in difficult surgeries, and (4) the constant emergence and application of new implantable biomaterials and other therapies. Thus, there is a pressing clinical need to improve the therapy of iatrogenic wounds. However, the difficulty in treating these wounds is considerable due to the emergence of drug-resistant bacteria, the high number of patients with metabolic diseases, and complex complications in patients. In particular, iatrogenic wounds caused by surgical site infections due to implantable biomaterials could lead to material leakage and conflicts regarding whether to retain or remove the implants. This review provides a definition of iatrogenic wounds, describes their characteristics, classifies them, and provides information about the importance of analyzing iatrogenic wounds. We hope that this review will provide useful information for the diagnosis and treatment of iatrogenic wounds and help to reduce their incidence in the future.

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Warfarin-Induced Skin Necrosis Following Heparin-Induced Thrombocytopenia

Cited by 12 publications

References 16 publications

COVID-19 Vaccine-Related Thrombosis: A Systematic Review and Exploratory Analysis

COVID-19 Vaccine-Related Thrombosis: A Systematic Review and Exploratory Analysis

Late-Onset Warfarin-Induced Skin Necrosis: A Standing Shadow

Iatrogenic wounds: a common but often overlooked problem

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