title: Coumarin-induced skin necrosis following heparin-induced thrombocytopenia and thrombosis. A case report.
abstract: A severe thrombotic thrombocytopenic status, induced by heparin in a sixty-nine-year-old woman undergoing total hip joint arthroplasty, was treated by switching the anticoagulant therapy to coumarin, which induced skin necrosis. There appeared to be a possible causal relation between the severe immune reaction to heparin and the condition that predisposed to skin necrosis in the presence of coumarin. In patients who express a strong immune response to heparin, a different anticoagulant approach other than use of coumarin congeners appears to be justified.
authors.affiliation: 2nd Department of Medicine, University Medical School, Debrecen, Hungary.
authors.forename: A
authors.initials: A
authors.lastname: Shahak
authors.forename: E
authors.initials: E
authors.lastname: Pósán
authors.forename: G
authors.initials: G
authors.lastname: Szücs
authors.forename: J
authors.initials: J
authors.lastname: Rigó
authors.forename: Z
authors.initials: Z
authors.lastname: Boda
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D003374:Coumarins / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006622:Hip Prosthesis; D006801:Humans; D009336:Necrosis; D011183:Postoperative Complications; D012871:Skin Diseases / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000150:complications
chemical_list: D000925:Anticoagulants; D003374:Coumarins; D006493:Heparin; C030123:coumarin