Case & reviewWarfarin-induced skin necrosis
Section snippets
Case history
A 79-year-old Venezuelan man with a history of McArdle disease, 36 pack-year former tobacco use, hypertension, and hyperlipidemia, status post-3-vessel coronary artery bypass grafting and aortic valve replacement, presented to our hospital with fatigue and chest discomfort. Admission medications included daily aspirin (81 mg) and warfarin (5 mg) for his mechanical aortic valve. A diagnostic cardiac catheterization procedure via a right femoral venous access site revealed aortic insufficiency
Discussion
Warfarin-induced skin necrosis (WISN) affects 0.01% to 0.1% of patients treated with anticoagulants and more than 200 cases worldwide have been identified to date.1, 8, 9, 10, 11 The first descriptions of this disorder came from the work of McLean12 in 1916 and, later, Flood et al13 in 1943 in the form of “thrombophlebitis migrans disseminata” of the breast.8 Thirteen additional cases were later reported by Verhagen3 in 1954 that identified warfarin as the causative agent of skin necrosis.1, 8
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Cited by (109)
Part II: Cutaneous manifestations of peripheral vascular disease
2023, Journal of the American Academy of DermatologySymmetrical peripheral gangrene in critical illness
2021, Transfusion and Apheresis ScienceDrug-induced cutaneous vasculitis and anticoagulant-related cutaneous adverse reactions: insights in pathogenesis, clinical presentation, and treatment
2020, Clinics in DermatologyCitation Excerpt :Without discontinuation of warfarin and treatment, areas of involvement progress to dry gangrene and thick eschar.110 The diagnosis of WSN can be made clinically; however, the main histopathologic findings include diffuse microthrombi within dermal and subcutaneous capillaries, venules, and deep veins; endothelial cell damage; erythrocyte extravasation; and overlying necrosis.104 Areas of late involvement demonstrate ulcers with necrotic eschar, hemorrhage, and a nonspecific neutrophilic infiltrate.109
Warfarin-induced major unilateral breast necrosis in a patient with antiphospholipid syndrome: A case report
2020, International Journal of Surgery Case ReportsCitation Excerpt :The most commonly affected patients are obese, middle-aged women, and the most affected areas contain subcutaneous fat, such as breasts, buttocks, thighs, and abdomen [17]. The condition typically occurs during the first days of starting warfarin; however, there are reported cases in which necrosis was described later [4,18,19]. It is an uncommon condition but causes calamitous complications with exceedingly rare association with a familial deficiency of protein C or protein S, and acquired protein S deficiency secondary to the development of antiphospholipid antibodies has also been reported [14,15].
Funding sources: None.
Conflicts of interest: None declared.
Presented in part at the 44th Annual Meeting of the American Society of Dermatopathology, Baltimore, MD, October 18-21, 2007.
Reprints not available from the authors.