Late Onset Warfarin-induced Skin Necrosis Research Articles

Late-onset Warfarin Induced Skin Necrosis: In a Hemodialysis Patient

Chronic dialysis patients frequently present with necrotic skin lesions. The differential diagnoses are broad and complex. The main focus of this paper is differentiating features of two diagnostic entities: Warfarin induced skin necrosis and calciphylaxis as early recognition and treatment may prevent the significant mortality. We discuss a case involving a hemodialysis patient, who developed necrotic skin lesions over her thighs and gluteal areas shortly after restarting warfarin for atrial fibrillation without heparin bridging therapy. Incisional biopsies and pathology report were consistent with warfarin induced skin necrosis. Significant improvement of the lesions following discontinuation of Warfarin was also confirming the diagnosis of Warfarin Induced Skin Necrosis.

Late-Onset Warfarin-Induced Skin Necrosis: A Standing Shadow

One of the clinical situations linked to the use of warfarin is the skin necrosis occurring in approximately 0.01 to 0.1% of all patients receiving warfarin. Typically, lesions develop during the first days after initiation of warfarin therapy (usually around the tenth day) and are often associated with the administration of a loading dose. The pathophysiological mechanisms for warfarin-induced skin necrosis, despite several theories, remain uncertain. For the diagnosis, along with a high degree of suspicion, a rapid recognition and management is required.

Late-Onset Warfarin-Induced Skin Necrosis: A Standing Shadow

Late-Onset Warfarin-Induced Skin Necrosis: A Standing Shadow

Late-Onset Warfarin-Induced Skin Necrosis: A Standing Shadow

Late-Onset Warfarin-Induced Skin Necrosis: A Standing Shadow

English

Warfarin induced skin necrosis (WISN) represents a rare complication of warfarin therapy that is associated with high incidence of morbidity and mortality. It usually presents in susceptible patients within 10 days of initiation of therapy. The study report a case of 24 years old gentleman who is known to have a unique rare inborn error of metabolism (primary hyperoxaluria), and was diagnosed with late onset WISN after being on warfarin for 28 months for recurrent pulmonary embolisms. The skin lesions in the study patient were not associated with underlying protein C or S deficiency. Key words: Warfarin induced skin necrosis, primary hyperoxaluria (PH), calciphylaxis, end stage renal disease (ESRD).

Late onset Warfarin induced skin necrosis in human immunodeficiency virus infected patient with pulmonary tuberculosis

The incidence of Warfarin-induced skin necrosis (WISN) is very low 0.01-0.10%. The majority of the WISN cases appear between day 3 and 6 of onset of Warfarin therapy. The cases of late onset WISN are rarely seen. We report a case of late onset WISN in a young human immunodeficiency virus positive female patient with thrombotic pulmonary embolism and reactivation of pulmonary tuberculosis.