Use of warfarin therapy at a target international normalized ratio of 3.0 for cutaneous polyarteritis nodosa.
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.
Kawakami
Tamihiro
T
Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan. tami@marianna-u.ac.jp
Soma
Yoshinao
Y
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
D000925:Anticoagulants; D014859:Warfarin; D011516:Prothrombin