Coumadin skin necrosis in a patient with a free protein S deficiency: case report and literature review.
Oral anticoagulants are widely used in clinical practice. Hemorrhagic complications are the most frequent adverse reactions, but a rarer complication, coumadin skin necrosis, also can be seen. The recently described association with low levels of protein C and/or free protein S is of importance in the pathophysiology of coumadin skin necrosis. This article describes the case of a patient with a functional protein S deficiency who developed coumadin skin necrosis. The condition is described, and a discussion of theories regarding its pathophysiology is presented. Current treatment recommendations are listed.
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Indiana University Medical Center, Indianapolis.
D000328:Adult; D001798:Blood Proteins / Q000172:deficiency; D005260:Female; D006023:Glycoproteins / Q000172:deficiency*; D006801:Humans; D009336:Necrosis / Q000139:chemically induced*; D011486:Protein C / Q000032:analysis; D017293:Protein S; D012867:Skin / Q000473:pathology*; D014859:Warfarin / Q000009:adverse effects*
D001798:Blood Proteins; D006023:Glycoproteins; D011486:Protein C; D017293:Protein S; D014859:Warfarin