title: Warfarin-induced skin necrosis following heparin-induced thrombocytopenia.
abstract: Anticoagulants, such as heparin and warfarin, are commonly used in the treatment and prevention of thromboembolic events. The risk of developing warfarin-induced skin necrosis (WISN) with warfarin is reported to be <1%. However, the risk of WISN may be increased with the initiation of warfarin in the setting of heparin-induced thrombocytopenia and thrombosis syndrome (HITT). WISN can lead to catastrophic tissue necrosis requiring amputations and mass debridement. This report describes a case of WISN following HITT and discusses the appropriate medical management of patients with HITT to avoid secondary WISN.
authors.affiliation: Texas A&M College of Medicine, Baylor Scott & White Health, Dallas, Texas (Fawaz, Tran); Cockerell Dermatopathology, University of Texas Southwestern Medical Center, Dallas, Texas (Candelario); and the University of Puerto Rico School of Medicine, San Juan, Puerto Rico (Rochet, Brau).
authors.forename: Bilal
authors.initials: B
authors.lastname: Fawaz
authors.affiliation: Texas A&M College of Medicine, Baylor Scott & White Health, Dallas, Texas (Fawaz, Tran); Cockerell Dermatopathology, University of Texas Southwestern Medical Center, Dallas, Texas (Candelario); and the University of Puerto Rico School of Medicine, San Juan, Puerto Rico (Rochet, Brau).
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Candelario
authors.affiliation: Texas A&M College of Medicine, Baylor Scott & White Health, Dallas, Texas (Fawaz, Tran); Cockerell Dermatopathology, University of Texas Southwestern Medical Center, Dallas, Texas (Candelario); and the University of Puerto Rico School of Medicine, San Juan, Puerto Rico (Rochet, Brau).
authors.forename: Nicole
authors.initials: N
authors.lastname: Rochet
authors.affiliation: Texas A&M College of Medicine, Baylor Scott & White Health, Dallas, Texas (Fawaz, Tran); Cockerell Dermatopathology, University of Texas Southwestern Medical Center, Dallas, Texas (Candelario); and the University of Puerto Rico School of Medicine, San Juan, Puerto Rico (Rochet, Brau).
authors.forename: Connie
authors.initials: C
authors.lastname: Tran
authors.affiliation: Texas A&M College of Medicine, Baylor Scott & White Health, Dallas, Texas (Fawaz, Tran); Cockerell Dermatopathology, University of Texas Southwestern Medical Center, Dallas, Texas (Candelario); and the University of Puerto Rico School of Medicine, San Juan, Puerto Rico (Rochet, Brau).
authors.forename: Cristina
authors.initials: C
authors.lastname: Brau