title: Recurrent warfarin-induced skin necrosis in kindreds with protein S deficiency.
abstract: Warfarin-induced skin necrosis is a rare complication of anticoagulant treatment. The incidence of this complication is undetermined, but it has been estimated to occur between 1:100 and 1:10,000 of patients treated with anticoagulants. Coumarin skin necrosis occurs almost exclusively in patients with venous thrombosis between the 3rd and 10th day after beginning anticoagulation. Although protein C deficiency is the most common underlying hypercoagulable state reportedly associated with warfarin skin necrosis, very few cases have been linked to congenital protein S deficiency. This article addresses the association of hereditary protein S deficiency and warfarin skin necrosis, and provides suggestions for management.
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, East Carolina University, School of Medicine, Greenville, NC 27858-4354, USA.
authors.forename: S
authors.initials: S
authors.lastname: Sallah
authors.forename: J M
authors.initials: JM
authors.lastname: Abdallah
authors.forename: G A
authors.initials: GA
authors.lastname: Gagnon
mesh_terms: D020016:Activated Protein C Resistance / Q000097:blood; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D000990:Antithrombin III / Q000032:analysis; D005165:Factor V / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010375:Pedigree; D011486:Protein C / Q000032:analysis; D017293:Protein S / Q000032:analysis; D018455:Protein S Deficiency / Q000097:blood / Q000188:drug therapy / Q000235:genetics*; D012008:Recurrence; D012867:Skin / Q000473:pathology*; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D011486:Protein C; D017293:Protein S; C095381:factor V Leiden; D014859:Warfarin; D000990:Antithrombin III; D005165:Factor V; D006493:Heparin