Marčić M, Marčić L, Titlić M, et al.
Acta medica Iranica. Date of publication 2016 Aug 1;volume 54(8):551-554.
1. Acta Med Iran. 2016 Aug;54(8):551-554.
Warfarin-Induced Skin Necrosis in Patients With Low Protein C Levels.
Marčić M(1), Marčić L(2), Titlić M(1).
Author information:
(1)Department of Neurology, School of Medicine, University of Split, Split,
Croatia.
(2)Department of Radiology, School of Medicine, University of Split, Split,
Croatia.
Warfarin-induced skin necrosis (WISN) is a rare complication of anticoagulant
therapy associated with a high incidence of morbidity and mortality requiring
immediate drug cessation. At particular risk are those with various thrombophilic
abnormalities, especially when warfarinisation is undertaken rapidly with large
loading doses of warfarin. Cutaneous findings include petechiae that progress to
ecchymosis and hemorrhagic bullae. With the increasing number of patients
anticoagulated as out-patients for thromboprophylaxis, we are concerned that the
incidence of skin necrosis may increase. We present a case of WISN with low
protein C level. He was a 50-year-old male who came to our department because of
acute infarction in irrigation area of the superior cerebellar artery. He had
intermittent atrial fibrillation and was started on anticoagulant therapy. After
few day of therapy, he developed skin necrosis, and his level of protein C was
low. Warfarin-induced skin necrosis is a rare but serious complication that can
be prevented by routine screening for protein C, protein S or antithrombin
deficiencies or for the presence of antiphospholipid antibodies before beginning
warfarin therapy.
PMID: 27701728 [Indexed for MEDLINE]
