Warfarin-induced skin necrosis This patient was diagnosed with bilateral DVT & began receiving intravenous heparin & warfarin. she was discharged 4 days after initiation of therapy. Diagnosis Warfarin-induced skin necrosis Warfarin-induced skin necrosis occurs in 0.01% to 0.1% of patients who begin receiving warfarin therapy. In 93% of cases, symptoms begin 3 to 6 days after initiation of therapy, but cases have been reported as late as 18 months. Diagnosis is made clinically, with rash, usually appearing over fatty areas, most commonly over the breasts, followed by the thighs/buttocks . Seventy-five percent of patients with warfarin-induced skin necrosis who begin receiving treatment for deep venous thrombosis or pulmonary embolism may have baseline-depleted protein C and S activity caused by consumption by the thrombotic process. Pathophysiology may also involve large loading doses of warfarin, thrombosis of superficial dermal capillaries, and inherited protein C and S deficiencies. Treatment entails discontinuation of warfarin and replenishing vitamin K–dependent factors, accompanied with debridement, grafting, or amputation as needed for skin necrosis. Heparin should be used for long-term treatment of thromboembolic events.
Posted on: Thu, 20 Mar 2014 09:48:51 +0000
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