HAL Id: hal-00571393
https://hal.archives-ouvertes.fr/hal-00571393
Submitted on 1 Mar 2011
HAL is a multi-disciplinary open access archive for the deposit and dissemination of sci- entific research documents, whether they are pub- lished or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers.
L’archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d’enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.
Coumarin skin necrosis: a severe complication of oral anticoagulation
Marianne Brodmann, Gerald Seinost, Ernst Pilger
To cite this version:
Marianne Brodmann, Gerald Seinost, Ernst Pilger. Coumarin skin necrosis: a severe complica- tion of oral anticoagulation. Vascular Medicine, SAGE Publications, 2006, 11 (4), pp.273-273.
�10.1177/1358863x06072229�. �hal-00571393�
A 39-year-old white female with severe peripheral arte- rial disease, due to fibromuscular dysplasia, developed coumarin-induced skin necrosis.
Owing to recurrent arterial thromboses, including one episode which resulted in left above-knee amputation, phenprocoumon therapy was initiated, at doses of 15, 9 and 3 mg on the first, second and third days of treat- ment, respectively. This treatment overlapped with a continuous intravenous infusion of heparin that was adjusted to aPTT levels of 1.5 to 2.5 times the normal range. On the third day of treatment she had an interna- tional ratio (INR)⬎4.5 (normal therapeutic range 2– 4.5);
the protein C level was below 5%. Heparin therapy was then stopped. Twenty-four hours later she developed severe pain of the left thigh, above the site of the ampu- tation, associated with extensive erythema. Another 24 hours later, petechial hemorrhages had developed (Panel A) and were rapidly followed by necrosis (Panel B). Oral anticoagulation was discontinued and
© 2006 SAGE Publications 10.1177/1358863x06072229
Images in vascular medicine
Coumarin skin necrosis: a severe complication of oral anticoagulation
Marianne Brodmann, Gerald Seinost and Ernst Pilger Vascular Medicine 2006; 11: 273
Division of Angiology, Department of Internal Medicine, Medizinische Universität Graz, Graz, Austria
Address for correspondence: Marianne Brodmann, Division of Angiology, Department of Internal Medicine, Medizinische Universität Graz, Auenbruggerplatz 15, A-8036 Graz, Austria.
Tel: ⫹43 316 385 80286; Fax: ⫹43 316 385 3788; E-mail:
low molecular weight heparin was resumed. Laboratory work-up indicated normal levels of protein C, protein S, antithrombin III, lupus anticoagulant and antiphospho- lipid antibodies. Testing for the factor V Leiden mutation was negative, as was testing for G 20210A mutation.
Within a 3-week period, the necrotic areas fully resolved spontaneously.
References
1 Kyrle P, Brockmeier J, Weltermann A et al. Inhibition rather than enhancement of hemostatic system activation during ini- tiation of oral anticoagulant treatment. Thromb Haemost 1997;
77: 685–89.
2 Stewart AJ, Penman ID, Cook MK, Ludlam CA. Warfarin- induced skin necrosis. Postgrad Med J 1999; 75: 233–35.
Panel A Panel B
‘Images in vascular medicine’ is a regular feature of Vascular Medicine. Readers may submit original, unpublished images related to clinical vascular medicine to: Mark A Creager, Editor in Chief, Vascular Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA.
