Skin and soft tissue necrosis may be an unexpected and unpredictable consequence of warfarin therapy, occurring in 0.01% to 0.1% of patients receiving the drug. Classically, the archetypal patient is female, middle-aged or older, and the area of necrosis occurs in areas of abundant fat, such as breast, thigh or abdomen. The onset begins three to 10 days after commencing therapy. Two cases of warfarin-related skin necrosis are presented. One is a classical abdominal presentation. The other is a much rarer presentation of warfarin necrosis affecting the hand. The implications of the variable presentations in terms of pathophysiology and treatment strategies are discussed.
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