A case of heparin-induced thrombocytopenia and warfarin skin necrosis is reported in a 62-year-old man treated for a subclavian venous thrombosis. These two complications occurring in the same patient have been reported only on two other occasions. Warfarin skin necrosis affecting the upper extremity has been reported only in four other patients.
Get full access to this article
View all access options for this article.
References
1.
1. Hirsh J. Raschke R. Warkentin TE, et al: Heparin: Mechanism of action, pharmacokinetics, dosing considerations, monitoring, efficacy, and safety. Chest108(suppl):258S-275S, 1995.
2.
2. Demasi R, Bode AP, Knupp C, et al: Heparin-induced thrombocytopenia. Am Surg60:26-29, 1994.
3.
3. Silver D, Kapsch DN, Rsoi EK: Heparin-induced thrombocytopenia, thrombosis and hemorrhage. Ann Surg198:301-305, 1983.
5. Thomas D, Block AJ: Thrombocytopenia, cutaneous necrosis, and gangrene of the upper and lower extremities in a 35-year-old man. Chest102:15781580, 1992.
6.
6. Rick M: Protein C and protein S. JAMA263:701703, 1990.
7.
7. Cole MS, Minifee PK, Wolma FJ: Coumarin necrosis-a review of the literature. Surgery103:271277, 1988.
8.
8. DeFranzo AJ, Marasco P, Argenta LC: Warfarin-induced necrosis of the skin. Am Plast Surg34:203208, 1995.
9.
9. Stone MS, Rosen T: Acral purpura: An unusual sign of coumarin necrosis. J Am Acad Dermatol14:797802, 1986.
11. Celoria GM, Steingart RH, Banson B, et al: Coumarin skin necrosis in a patient with heparin-induced thrombocytopenia-a case report. Angiology39:915920, 1988.
12.
12. Gallerani M, Manfredini RMoratelli S: Non-haemorrhagic adverse reactions of oral anticoagulant therapy. Int J Cardiol49:1-7, 1995.
13.
13. Rowbotham B, Clouston W, Kime N, et al: Coumarin skin necrosis without protein C deficiency. Aust NZ J Med16:513-513, 1986.
14.
14. Anderson DR, Brill-Edwards P. Walker I: Warfarininduced skin necrosis in 2 patients with protein S deficiency: Successful reinstatement of warfarin therapy. Haemostasis22:124-128, 1992.
15.
15. Berkompas DC: Warfarin skin necrosis in a patient with a free protein S deficiency: Case report and literature review. Indiana Med84:788-791, 1991.
16.
16. Drakos P, Uziely BNagler A: Successful administration of low molecular weight heparin in a patient with heparin-induced thrombocytopenia and coumarin-induced skin necrosis. Haemostasis23:259-262, 1993.
