Warfarin-Induced Skin Necrosis

Inayatullah, Seema; Phadke, Gautam; Vilenski, Leonid; Pasya, Suresh Kumar; Albrecht, Warren

doi:10.1097/smj.0b013e3181c47dcf

Cited by 6 publications

(2 citation statements)

References 4 publications

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“…Patient phenotype More commonly female, obese and being treated for DVT or PE2 Associated protein C, S or antithrombin III deficiencies2 8 Phospholipid antibodies7 …”

Section: Discussionmentioning

confidence: 99%

Warfarin-induced skin necrosis diagnosed on clinical grounds and treated with maggot debridement therapy

Biscoe

Bedlow

2013

BMJ Case Reports

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A patient with a history of deep vein thrombosis presented with painful bruising and blistering on his left leg 7–10 days after warfarin treatment. A complicated 2-month treatment followed, where vasculitis was originally diagnosed from histological findings before the final diagnosis of warfarin-induced skin necrosis (WISN) was made on clinical grounds. Warfarin was stopped, reversed and low molecular weight heparin started but, the lesions had progressed to full thickness necrosis. This was originally treated with conventional surgical debridement before introducing maggot debridement therapy (MDT) in an effort to try to salvage the limb.

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“…Patient phenotype More commonly female, obese and being treated for DVT or PE2 Associated protein C, S or antithrombin III deficiencies2 8 Phospholipid antibodies7 …”

Section: Discussionmentioning

confidence: 99%

Warfarin-induced skin necrosis diagnosed on clinical grounds and treated with maggot debridement therapy

Biscoe

Bedlow

2013

BMJ Case Reports

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“…Best practice guidelines recommend anticoagulation with a vitamin K antagonist (VKA) (e.g., warfarin) in patients with a mechanical prosthetic valve and for a minimum of 3 months in patients with a bioprosthetic mitral or aortic valve replacement [7]. However, there are patients with ESRD in whom warfarin therapy is relatively or absolutely contraindicated, such as in pregnancy [8], warfarin-induced skin necrosis (WSN) [9], and calcific uremic arteriolopathy (CUA) [10], previously called calciphylaxis. The optimal anticoagulation strategy in such cases remains uncertain.…”

Section: Introductionmentioning

confidence: 99%

A Scoping Review of Alternative Anticoagulation Strategies for Hemodialysis Patients with a Mechanical Heart Valve

et al. 2021

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Introduction: Patients with end-stage renal disease (ESRD) have high rates of cardiac valvulopathy but can develop contraindications for vitamin K antagonist (VKA) therapy. We explored the evidence for alternative anticoagulation strategies in patients with ESRD with a contraindication for VKA therapy. Methods: A scoping review was completed, searching MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Conference abstracts from inception to March 30, 2021. The study population was patients with ESRD who were on VKA therapy and developed a contraindication to VKA therapy use. All data regarding studies, patient characteristics, anticoagulation strategy, and clinical outcomes were summarized. Results: Twenty-three articles met inclusion criteria. These articles included 57 patients. Contraindications to VKA therapy included calcific uremic arteriolopathy (CUA) (n = 55) and warfarin-induced skin necrosis (n = 2). All studies were either case reports or case series. There were 10 anticoagulation strategies identified. Continuation of VKA therapy was associated with increased death and decreased rates of CUA resolution (80.0% and 10.0%, respectively), compared to apixaban (24.0% and 70.8%), subcutaneous (SC) low-molecular-weight heparin (LMWH) (14.3%, 85.7%), and SC unfractionated heparin (0.0%, 100.0%). While only 5 patient cases were reported with mechanical heart valves, SC LMWH use has been reported in this context with good outcomes. Conclusions: In patients with ESRD who develop a contraindication to VKA therapy, several alternative anticoagulation strategies have been reported with superior outcomes to VKA continuation. While outcomes appear superior to continuation of VKA therapy, more data are required before definitive recommendations can be made for the patient with ESRD and a mechanical heart valve.

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Thrombotic Disorders

Alice

2012

Hemophilia and Hemostasis

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Warfarin-Induced Skin Necrosis

Cited by 6 publications

References 4 publications

Warfarin-induced skin necrosis diagnosed on clinical grounds and treated with maggot debridement therapy

Warfarin-induced skin necrosis diagnosed on clinical grounds and treated with maggot debridement therapy

A Scoping Review of Alternative Anticoagulation Strategies for Hemodialysis Patients with a Mechanical Heart Valve

Thrombotic Disorders

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