Warfarin-induced skin necrosis associated with Factor V Leiden and protein S deficiency.
Thrombotic events are rare complications during anticoagulation therapy. The thrombosis varies from localized cutaneous involvement to catastrophic thromboembolism and is usually associated with an underlying thrombophilia. We describe a patient who developed skin necrosis during warfarin treatment for a pulmonary thromboembolism. The management was complicated by the development of heparin-induced thrombocytopenia and further thrombotic events. Thrombophilia screen demonstrated the presence of protein S deficiency and Factor V Leiden as the prothrombotic factors, together with the demonstration of antiplatelet factor 4 antibodies, which confirms the diagnosis of heparin-induced thrombocytopenia (type II). Reinstitution of warfarin at a low loading dose was successful without the recurrence of skin lesions nor any further thrombosis.
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Department of Haematological Medicine, King's College Hospital, Denmark Hill, London, UK. tsfng@hotmail.com
Tillyer
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D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001323:Autoantibodies / Q000097:blood; D005165:Factor V / Q000009:adverse effects; D005260:Female; D006801:Humans; D009336:Necrosis; D010976:Platelet Count; D010978:Platelet Factor 4 / Q000276:immunology; D018455:Protein S Deficiency / Q000150:complications; D011696:Purpura, Thrombocytopenic / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis; D012867:Skin / Q000473:pathology*; D012871:Skin Diseases / Q000097:blood / Q000139:chemically induced*; D019851:Thrombophilia / Q000150:complications*; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
D000925:Anticoagulants; D001323:Autoantibodies; C095381:factor V Leiden; D010978:Platelet Factor 4; D014859:Warfarin; D005165:Factor V