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Warfarin induced skin necrosis

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    By Katherine Kozlowski, Medical Contributor to Vein News

    What is Warfarin?

    Warfarin (a.k.a. Coumadin) is an anticoagulant (blood thinner) used to treat or prevent blood clots.

    One rare, but debilitating complication is warfarin-induced skin necrosis. This is death of skin tissue due to a lack of blood flow and oxygen to the area.  This usually happens between days 3 and 10 of treatment.

    Who is at risk for Warfarin-induced skin necrosis?

    Patients who have a deficiency in Protein C and S are at the highest risk for this complication because Warfarin decreases these proteins through its mechanism of action.

    What areas of the body are most commonly affected?

    Subcutaneous fatty areas of the body such as the breasts, thighs, abdomen, buttocks, and penis.

    How is this condition treated?

    If a patient has warfarin-induced skin necrosis, Warfarin therapy should be stopped, and patients may begin IV Heparin therapy, vitamin K supplementation, fresh frozen plasma transfusion, and/or activated protein C supplementation.

    If there is extensive skin damage, patients may need excision, debridement (removing infected/damaged skin and tissue), and/or skin grafting.

    Jaff M, Mintz B, Mintz J et al. Atlas of Clinical Vascular Medicine. John Wiley & Sons; 2013.