Treatment of coumarin-induced skin necrosis with a monoclonal antibody purified protein C concentrate.
BACKGROUND AND DESIGN--Protein C is a vitamin K-dependent plasma protein that is converted to the serine protease activated protein C by the thrombin-thrombomodulin complex. Activated protein C functions as a natural anticoagulant by inactivating the cofactors of the coagulation cascade, factors Va and VIIIa. Coumarin (warfarin)-induced skin necrosis is thought to be due to a rapid elimination of protein C relative to other vitamin K-dependent factors during the initial phase of oral anticoagulation. We have used a highly purified protein C concentrate to treat a patient with acquired protein C deficiency who developed skin necrosis during the initial phase of oral anticoagulant therapy. OBSERVATIONS AND CONCLUSIONS--During protein C concentrate therapy, no further skin lesions appeared, and the healing process of necrotic areas was facilitated. Replacement therapy with protein C concentrate appears to be safe and effective as an adjunctive treatment for coumarin-induced skin necrosis.
Medizinische Klinik Innenstadt, University of Munich, Germany.
W
W
Schramm
M
M
Spannagl
K A
KA
Bauer
R D
RD
Rosenberg
B
B
Birkner
Y
Y
Linnau
H P
HP
Schwarz
D000368:Aged; D003374:Coumarins / Q000009:adverse effects*; D005260:Female; D006801:Humans; D009336:Necrosis / Q000139:chemically induced / Q000628:therapy; D011486:Protein C / Q000627:therapeutic use*; D020151:Protein C Deficiency; D012867:Skin / Q000187:drug effects / Q000473:pathology*
D003374:Coumarins; D011486:Protein C; C030123:coumarin