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Warfarin-induced skin necrosis.

Neda Pourdeyhimi1, Zackery Bullard1

  • 1Department of Pharmacy, New Hanover Regional Medical Center , Wilmington, North Carolina.

Hospital Pharmacy
|February 13, 2015
PubMed
Summary

Warfarin-induced skin necrosis is a rare adverse effect of anticoagulant therapy. Prompt treatment with vitamin K and fresh frozen plasma (FFP) can reverse its effects and promote healing.

Keywords:
protein C deficiencypurple toe syndromewarfarinwarfarin adverse effectswarfarin effectswarfarin-induced skin necrosis

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Area of Science:

  • Cardiology
  • Dermatology
  • Pharmacology

Background:

  • Warfarin is a common oral anticoagulant.
  • Warfarin-induced skin necrosis is a rare adverse effect.
  • The pathophysiology and treatment of this condition are not well-established.

Purpose of the Study:

  • To present a case of warfarin-induced skin necrosis.
  • To discuss the management of this rare complication.

Main Methods:

  • A 52-year-old female with deep vein thrombosis (DVT) was treated with warfarin and enoxaparin.
  • The patient developed warfarin-induced skin necrosis with a supra-therapeutic INR.
  • Treatment included intravenous vitamin K and fresh frozen plasma (FFP).

Main Results:

  • The patient's INR normalized after treatment with vitamin K and FFP.
  • Necrotic lesions improved, and enoxaparin was restarted for DVT.
  • The patient was discharged with an anticipated full recovery.

Conclusions:

  • Adequate bridge therapy may prevent warfarin-induced skin necrosis.
  • Early recognition and treatment with vitamin K, FFP, or 4-factor prothrombin complex concentrate are crucial.
  • Continued wound care is essential for preventing complications.