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Updated: Mar 28, 2026

Comprehensive Analysis of Procoagulant Platelets Exhibiting Features of Necrosis, Apoptosis and Platelet Activation
Published on: May 23, 2025
Warfarin-induced skin necrosis following heparin-induced thrombocytopenia
Bilal Fawaz1, Nicole M Candelario1, Nicole Rochet1
1Texas A&M College of Medicine, Baylor Scott & White Health, Dallas, Texas (Fawaz, Tran); Cockerell Dermatopathology, University of Texas Southwestern Medical Center, Dallas, Texas (Candelario); and the University of Puerto Rico School of Medicine, San Juan, Puerto Rico (Rochet, Brau).
Abstract:
Anticoagulants, such as heparin and warfarin, are commonly used in the treatment and prevention of thromboembolic events. The risk of developing warfarin-induced skin necrosis (WISN) with warfarin is reported to be <1%. However, the risk of WISN may be increased with the initiation of warfarin in the setting of heparin-induced thrombocytopenia and thrombosis syndrome (HITT). WISN can lead to catastrophic tissue necrosis requiring amputations and mass debridement. This report describes a case of WISN following HITT and discusses the appropriate medical management of patients with HITT to avoid secondary WISN.
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