Skin necrosis, a rare complication of coumarin therapy

Coumarin congeners are frequently being prescribed in vascular surgery. The complication most often seen in haemorrhage. A less known complication is necrosis of skin and soft tissues. This rare complication is potentially lethal. The etiology is unclear, a relation with protein C deficiency seems likely. Early treatment with vitamin K and heparin may prevent the skin necrosis. After necrosis has occurred, surgical intervention is usually necessary.