Cutaneous necrosis induced by acenocoumarol.
Cutaneous necrosis is an infrequent but well-documented complication of oral anticoagulants. In the pathogenesis of cutaneous necrosis induced by oral anticoagulants recent hypotheses favour the combined role of local factors and a transient unbalance of coagulation mechanisms leading to an hypercoagulable state. There exists a genetic factor that determines a decreased level of two vitamin-K dependent glycoproteins, namely protein C and protein S. We present the case of an obese woman that developed an extensive cutaneous necrosis while receiving acenocoumarol for a deep venous thrombosis. She had an heterozygous deficit for protein C. The histopathologic findings of vessel thrombi and red blood cell extravasation were consistent with the clinical picture. A biopsy specimen taken from an initial lesion disclosed images of leucocytoclastic vasculitis. We reviewed the literature focusing on the pathogenesis and the histopathology of the disease.
Valdivielso
M
M
Servicio de Dermatología, Hospital 'Gregorio Marañón', Madrid, Spain.
Longo
I
I
Lecona
M
M
Lázaro
P
P
D000074:Acenocoumarol / Q000008:administration & dosage / Q000009:adverse effects*; D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D009336:Necrosis; D020151:Protein C Deficiency / Q000150:complications; D012867:Skin / Q000473:pathology*; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000150:complications / Q000473:pathology
D000925:Anticoagulants; D000074:Acenocoumarol