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Warfarin-induced skin necrosis.

Despoina D Kakagia1, Nikolaos Papanas2, Efthimios Karadimas3

  • 1Department of Surgery-Plastic Surgery, Democritus University of Thrace, Alexandoupolis, Greece.

Annals of Dermatology
|March 21, 2014
PubMed
Summary
This summary is machine-generated.

Warfarin-induced skin necrosis is a rare complication. Early diagnosis and stopping warfarin, often with heparin, are key to preventing its progression and ensuring healing.

Keywords:
AnticoagulantsNecrotic lesionsWarfarin

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Area of Science:

  • Dermatology
  • Pharmacology
  • Hematology

Background:

  • Warfarin is an anticoagulant medication.
  • Warfarin-induced skin necrosis (WISN) is a rare but serious complication.
  • WISN is associated with thrombophilia or high initial warfarin doses without heparin.

Observation:

  • A 62-year-old female patient developed skin necrosis 4 days after starting 5 mg daily warfarin.
  • She did not receive initial heparin co-administration.
  • Her clotting profile was normal.

Findings:

  • Discontinuing warfarin and initiating heparin halted the progression of skin necrosis.
  • Reintroducing warfarin at a lower dose (2 mg daily) with low molecular weight heparin allowed for healing.
  • Autolytic debridement facilitated wound healing by secondary intention.

Implications:

  • Prompt diagnosis and warfarin cessation are critical for managing WISN.
  • Heparinization is crucial during initial warfarin therapy, especially in predisposed individuals.
  • This case highlights the importance of careful warfarin initiation protocols to mitigate risks.