Ann Dermatol.  2014 Feb;26(1):96-98. 10.5021/ad.2014.26.1.96.

Warfarin-Induced Skin Necrosis

• Kakagia DD
• Papanas N
• Karadimas
• Polychronidis A

• KMID: 2265704
• DOI: http://doi.org/10.5021/ad.2014.26.1.96

Abstract

Warfarin-induced skin necrosis is an infrequent complication occurring in individuals under warfarin treatment who have a thrombophilic history or after administration of large loading doses of warfarin particularly without simultaneous initial use of heparin. A 62-year-old lady developed skin necrosis 4 days after initiating warfarin therapy of 5 mg daily without initial co-administration of heparin. The patient had a normal clotting profile. Skin necrosis progressed to eschar formation after cessation of warfarin and heparinization stopped expanding. Warfarin was reintroduced at 2 mg daily, initially together with low molecular weight heparin. Autolytic debridement of the necrotic tissue was followed by healing of the cutaneous deficit by secondary intention. Prompt diagnosis and discontinuation of warfarin are crucial for the prognosis.

Keyword

Anticoagulants; Necrotic lesions; Warfarin

MeSH Terms

Anticoagulants
Debridement
Diagnosis
Heparin
Heparin, Low-Molecular-Weight
Humans
Intention
Middle Aged
Necrosis*
Prognosis
Skin*
Warfarin
Anticoagulants
Heparin
Heparin, Low-Molecular-Weight
Warfarin

Figure

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  Fig. 1 (A) Clinical appearance of the patient and (B) histopathologic examination of the cutaneous necrosis (H&E, ×200): skin necrosis with evidence of fibrin deposits in the post capillary venules, absence of arteriolar thrombosis, and lack of vascular or perivascular inflammation.

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