Property | Value |
Name | Skin Necrosis induced by warfarin and associated protein C deficiency |
Description | Case report:- Microbiology B.Kiran Madhusudhan1* & B.Madhusudhan2 1MD (Microbiology), Associate Professor in Microbiology, Barath University, Shree Balaji Medical College and Hospital, Chrompet, Chennai-600 044, India. 2MS.,M.Ch(Plastic)-Consultant Plastic Surgeon BRS Hospital Pvt Ltd, Nungambakkam, Chennai-34, India.
Abstract: Protein C deficiency is a common cause for hypercoagulable state and can be inherited or acquired. Early in warfarin treatment, serum levels of vitamin K dependent antithrombotic protein C falls, even before other clotting factors. This causes a temporary prothrombic state, leading to venous thrombosis in subcutaneous and dermal vessels causing haemorrhagic infarction and skin necrosis. We report here a post aortic valve replacement patient who presented with a painful necrotic skin lesion of 2 weeks duration on the medial aspect of his right thigh .Patient was on anticoagulant treatment (T.Acitrom-5mg od) and his protein C level was well below normal limits, which helped in the diagnosis of warfarin induced skin necrosis in this case. Reversal of warfarin therapy was adopted, followed by surgical debridement and skin grafting.
Key words:- Skin necrosis, Warfarin, Hypercoagulable state, Protein C deficiency.
References:- 1.Schafer. Al. Thrombotic Disorders:hypercoagulable states.In Goldman.L,Ausiello D.eds Cecil Medicine .,23rd Edition Philadelphiala ,Pa Saunders Elsevier; 2007, Chapter 182. 2.Andrew’s Disease of Skin by Sauders Jane;10th Edition Pg122-123. 3.Mcknight JT,Maxwell AJ,Anderson RL(1992).”Warfarin necrosis”,Arch Fam Med (1);105-8,PMID 141581 4.James,William Berger,Timothy,Elston Drik(2005).Andrew’s Diseases of the skin; Clinical Dermatology 1oth Ed Saunders ISBN 0-7216-2921-0. 5.Schleicher SM,Fricker MP(April 1980). “Courmarin necrosis”.Arch Dermatol 116 (4); 444-5.PMID 7369776. 6.Chan YC,Valeti D, Mansfield AO ,standsby G (March 2000).”Warfarin induced skin necrosis” Br.J surg 87(3);266-72. 7.Chan YC,Valeti D, Mansfield AO ,standsby G (March 2000).”Warfarin induced skin necrosis” Br.J surg 87(3);266-72. 8.A.D.A.M.Medical Encyclopedia .Atlanta (GA) A.D.A.M; 2011.
Copyright © 2013 B.Kiran Madhusudhan & B.Madhusudhan. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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