warfarin induced skin necrosis by: mohammed alsaidan
TRANSCRIPT
Warfarin Induced Skin Necrosis
BY: MOHAMMED ALSAIDAN
Warfarin induced skin necrosis
• (WISN) affects 0.01% to 0.1% of patients on warfarin
• 3 to 10 days after the initiation of therapy
• In areas with increased subcutaneous fat such as the abdomen, buttocks, thighs, legs, and mammary tissue
• 33% multiple sites.
Warfarin induced skin necrosis
• Acute onset of paresthesia and edema petechiae and ecchymosis well-demarcated hemorrhagic bullae within 24 hours painful coagulative full-thickness skin necrosis with formation of deep subcutaneous ulcers
Warfarin induced skin necrosis
VKAs
• Coumarin derivatives :• Bishydroxycoumarin (Dicumarol)• Warfarin (Coumadin®)
• Analog #42 (1945) of many coumarins synthesized by Dr Link and named by him as WARFarin for the Wisconsin Alumni Research Foundation and coumARIN
Pathophysiology
Histopathology
• Diffuse microthrombi within dermal and subcutaneous capillaries, venules, and deep veins
• Endothelial cell damage resulting in ischemic skin necrosis and marked RBC extravasation
• No vascular inflammation and arterial involvement
Management
• Early diagnosis and drug withdrawal improve prognosis
• (Fresh frozen plasma, vitamin K) +/- Heparin
• Systemic antibiotic
• Protein C concentrates
• Local treatment• topical bactericidal agents• surgical debridement +/- skin grafting,• mastectomy, or amputation
Warfarin Again?
• Controversy