Skin Necrosis Complicating Oral Anticoagulant Therapy

Abstract

Since the first report in 1943 far more than 100 cases of skin necrosis as a complication of oral anticoagulant therapy have been reported, mainly in European countries. Breast, thigh, legs and abdomen are the predominant sites of the lesions, obese women are most frequently affected.10 cases which we observed over the last ten years are presented and the etiology is discussed. The common feature of our patients is a history of fever, probably caused by a bacterial or viral infection, treated with a variety of antibiotics. A complicating or preexisting thrombosis or thrombophlebitis of the leg leads to the initiation of oral anticoagulant therapy. Regularly on the 4th (3.-5.) day of anticoagulant treatment the skin necrosis develops within hours. We suggest that the administration of antibiotics, and perhaps also the infectious process are predisposing factors. The high loading dose at the beginning of coumarin treatment and an abnormal sensitivity of the patient seem to be other important etiologic factors for coumarin necrosis. These points are substantiated by the facts that skin necrosis occurs only in the first days after the start of oral anticoagulant therapy, and by one of our patients who developed another skin necrosis when coumarin therapy was repeated several years later. Oral anticoagulant therapy should not be initiated when antibiotics must be given at the same time. In case anticoagulant treatment is necessary during antibiotic therapy we propose the administration of heparin instead of using coumarin derivatives.