title: Use of warfarin therapy at a target international normalized ratio of 3.0 for cutaneous polyarteritis nodosa.
abstract: BACKGROUND
  Cutaneous polyarteritis nodosa (CPN) is an uncommon disorder that can be difficult to manage effectively. We have previously suggested that CPN might be associated with the presence of anti-phosphatidylserine-prothrombin complex (anti-PS/PT) antibodies, members of the antiphospholipid antibody family.
  
  
  OBJECTIVE
  To evaluate clinical manifestations and effective treatments of CPN.
  
  
  METHODS
  We conducted a retrospective analysis of three patients with CPN who responded to warfarin therapy. IgG and IgM anti-PS/PT antibodies were measured with a specific enzyme-linked immunosorbent assay.
  
  
  RESULTS
  There was a dramatic improvement in our three CPN patients following warfarin therapy adjusted to a target international normalized ratio (INR) of about 3.0. Active disease progression was halted by sustained warfarin therapy during which the patients experienced resolution of their skin manifestations.
  
  
  CONCLUSIONS
  A small number of cases were studied and the study design was retrospective.
  
  
  CONCLUSIONS
  We propose that warfarin therapy at a target INR of roughly 3.0 could be effective for treating patients with CPN. We further believe that treatment with warfarin led to the effective attenuation of anti-PS/PT antibodies related to prothrombin, and improved the symptoms in our CPN patients.
authors.affiliation: Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan. tami@marianna-u.ac.jp
authors.forename: Tamihiro
authors.initials: T
authors.lastname: Kawakami
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Soma
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D001707:Biopsy, Needle; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D019934:International Normalized Ratio; D007871:Leg Ulcer / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D008875:Middle Aged; D010488:Polyarteritis Nodosa / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D011516:Prothrombin / Q000187:drug effects / Q000378:metabolism; D012189:Retrospective Studies; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*; D014945:Wound Healing / Q000187:drug effects; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D011516:Prothrombin