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Coumarin necrosis induced by renal insufficiency
C Muniesa1, J Marcoval, A Moreno
1Department of Dermatology, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 Barcelona, Spain. cristinamuniesa@hotmail.com
The British Journal of Dermatology
|August 26, 2004
Summary
Coumarin-induced skin necrosis, a rare complication, can occur with transient protein C deficiency. This case highlights how acute kidney injury from diclofenac may trigger this deficiency, leading to skin necrosis.
Area of Science:
- Pharmacology
- Dermatology
- Nephrology
Background:
- Cutaneous necrosis is a rare adverse effect of coumarin anticoagulants.
- It is typically associated with congenital deficiencies of protein C or protein S.
- Acquired or transient deficiencies can also lead to this complication.
Observation:
- A 75-year-old male on long-term acenocoumarol developed skin necrosis.
- The event followed the initiation of diclofenac for knee pain, coinciding with renal function deterioration.
- Histopathology confirmed coumarin-induced necrosis; protein C and S levels were normal.
Findings:
- The patient experienced acute renal insufficiency, potentially exacerbated by diclofenac and inadvertent drug withdrawal.
- This renal impairment likely precipitated a transient protein C deficiency.
- This transient deficiency, in the context of coumarin therapy, led to skin necrosis.
Implications:
- This case suggests that acute kidney injury can precipitate transient protein C deficiency in patients on coumarin therapy.
- Clinicians should be aware of the potential for coumarin-induced skin necrosis in patients with drug-induced renal impairment.
- Careful monitoring of renal function and anticoagulant status is crucial when co-administering NSAIDs with coumarins.