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2004, Number 2

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Acta Med 2004; 2 (2)

Acenocoumarol-Associated Dermal Necrosis

Curn de ES, Paredes GR, Escobar CGA

Language: Spanish
References: 26
Page: 117-120
PDF size: 51.33 Kb.


ABSTRACT

We present the first published report in Mexico, and perhaps in the world literature, of necrosis in conjunction with use of Acenocumarol in a 36-year-old female patient. Lesions are similar to those reported for warfarin, although the patient did not present the majority of risk factors. The patient is relatively young, not obese, and did not initially show alterations in her protein C (although 4 months later, a control study showed a deficiency of protein C). Use of warfarin derivatives is very common but the complete effect on the coagulation cascade is not known. Although this complication may occur even if all risk factors are not present, the authors suggest that a longer protection time with heparin and more complete studies to assure that therapeutic ranges are reached should be routinely carried out prior to initiation of warfarin or acenocumarol. Greater awareness of this complication is imperative because once necrosis is established, it does not afford the physician many treatment options and results are far from satisfactory.


REFERENCES

  1. Bick RL, Kaplan H. Syndromes of thrombosis and hypercoagulability. Congenital and acquired causes of thrombosis. Med Clin North Am 1998; 82: 409-58.

  2. Adams JG, Silver D. Deep Venous thrombosis & Pulmonary Embolism. In: Dean RH editor. Current diagnosis and treatment in vascular surgery. New Jersey, USA: Appleton and Lange; 1995; 33: 375-7.

  3. Gibson GE. Antiphospholipid syndrome and the skin. J Am Acad Dermatol 1997; 36: 970-82.

  4. Goldhaber S. Pulmonary embolism. N Engl J Med 1998; 339: 93-104.

  5. Escobar G, Curn S. Diagnóstico etiológico de la trombosis venosa en miembros inferiores. Arch Inst Cardiol Mex 1971; 41-3: 264-272.

  6. Brigden ML. The hypercoagulable state. Who, how and when to test and treat. Postgrad Med 1997; 101: 249-52, 254-6, 259-62.

  7. Rizk NW, Kalassian KG et al. Obstetric complications in pulmonary and critical care medicine. Chest 1996; 110: 791-809.

  8. Mason E. Medical problems during pregnancy. Med Clin North Am 1998; 82: 249-69.

  9. Machie MJ, Douglas, AS. Drug-induced disorders of coagulation. In: Rapnoff OD, Forbes CD editors. Disorders of hemostasis. Philadelphia, PA, USA: W.B. Saunders; 1991: 293-517.

  10. Gelwix TJ, Beeson MS. Warfarin induced skin necrosis. Am J Emerg Med 1998; 16: 541-3.

  11. Hirsh J, Dalen JE, Anderson DR et al. Fifth ACCP Consensus Conference on Antithrombotic Therapy. The American College of Chest Physicians, 1998; 114: 445-65.

  12. Ginsberg GS. Management of venous thromboembolism. N Engl J Med 1996; 335: 1816-28.

  13. Neuerburg JM. Results of a multicenter study of the retrievable tulip vena cava filter: early clinical experience. Cardiovasc Intervent Radiol 1997; 20: 10-6.

  14. Bick RL, Haas SK. Current concepts of thrombosis: prevalent trends for diagnosis and management. Med Clin North Am 1998; 82: 613-33.

  15. Wynn S, Jin DK, Essex DW. Warfarin induced skin necrosis occuring four days after discontinuation of warfarin. Haemostasis 1997; 27: 246-50.

  16. Miura Y, Argenghy M, Ramasastry S et al. Coumarin necrosis of the skin: Report of four patients. Ann Plast Surg 1996; 37: 332-7.

  17. Stahmann MA, Heubner CF, Link KP. Studies on the hemorrhagic sweet clover disease: V. Identification and synthesis of the hemorrhagic agent. J Biol Chem 1941; 138: 513-527.

  18. Sternberg ML. Warfarin sodium-induced skin necrosis. Ann Emerg Med 1995; 26: 94-7.

  19. De Franzo AJ, Marasco P, Argenta LC. Warfarin Induced Skin Necrosis of the Skin. Ann Plast Surg 1995; 34: 203-208.

  20. Essex DW, Winn S, Jin DK. Late onset warfarin-induced skin necrosis. Am J Haematol 1998; 57: 233-7.

  21. Gallerani M, Manfredini R, Mortatelli S. Non-haemorrhagic adverse reactions of anticoagulant therapy. Int J Card 1995; 49: 1-7.

  22. Kearon C, Gent M et al. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med 1999; 340: 901-7.

  23. Schafer AI. Venous thrombosis as a chronic disease. N Engl J Med 1999; 340: 955-6.

  24. Triplett DA. Current recommendations for warfarin therapy. Use and monitoring. Med Clin North Am 1998; 82: 601-11.

  25. Yang Y, Algazy KM et al. Warfarin-induced skin necrosis in a patient with a mutation of the prothrombin gene (Letter). N Engl J Med 1999; 340: 735.

  26. Jillella AP, Lutcher CL. Reinstituting warfarin in patients who develop skin necrosis. Am J Haematol 1996; 52: 117-9.




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