Warfarin-induced skin necrosis: Difference between revisions
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*Differing half-lives of Vitamin-K dependent coagulation factors leads to relative protein C deficiency initially→ hypercoagulability | *Differing half-lives of Vitamin-K dependent coagulation factors leads to relative protein C deficiency initially→ hypercoagulability | ||
*Onset usually in first week of starting [[warfarin]] | *Onset usually in first week of starting [[warfarin]] | ||
==Clinical Features== | ==Clinical Features== | ||
*Painful, red lesions over extremities, trunk, penis | *Painful, red [[rash|lesions]] over extremities, trunk, penis | ||
*Start with erythematous macule→ edema→ central purpuric zones → necrosis | *Start with erythematous macule→ edema→ central purpuric zones → necrosis | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Necrotizing Rashes DDX}} | |||
==Evaluation== | ==Evaluation== | ||
*Clinical diagnosis | |||
==Management== | ==Management== | ||
*Stop warfarin | *Stop warfarin | ||
*[[Low molecular weight heparin]] or unfractionated [[heparin]] | *[[Low molecular weight heparin]] or unfractionated [[heparin]] | ||
==Disposition== | ==Disposition== | ||
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[[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
[[Category:Dermatology]] | |||
Revision as of 19:29, 1 October 2019
Background
- Differing half-lives of Vitamin-K dependent coagulation factors leads to relative protein C deficiency initially→ hypercoagulability
- Onset usually in first week of starting warfarin
Clinical Features
- Painful, red lesions over extremities, trunk, penis
- Start with erythematous macule→ edema→ central purpuric zones → necrosis
Differential Diagnosis
Necrotizing rashes
- Necrotizing soft tissue infections
- Purpura fulminans
- Drug rash
- Levamisole toxicity
- Heparin-induced skin necrosis
- Warfarin-induced skin necrosis
Evaluation
- Clinical diagnosis
Management
- Stop warfarin
- Low molecular weight heparin or unfractionated heparin