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.
Servicio de Dermatología, Hospital 'Gregorio Marañón', Madrid, Spain.
M
M
Valdivielso
I
I
Longo
M
M
Lecona
P
P
Lázaro
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