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Nader G, Yavari M, Timilsina A, Rayamajhi S. A Case of Successful Direct Oral Anticoagulant Use for the Treatment of Warfarin-Induced Vasculitis in a Patient With Left Ventricular Thrombus. Cureus 2023; 15:e50885. [PMID: 38249209 PMCID: PMC10799545 DOI: 10.7759/cureus.50885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Cutaneous small vessel leukocytoclastic vasculitis (LCV) is isolated to the dependent areas of the skin. LCV can be induced by pharmaceutical drugs, and management requires abrupt discontinuation of the offending drug. Warfarin is a rare medication to cause LCV, with sparse literature to date. Here, we present a case of warfarin-induced LCV, complicated by a patient's comorbid left ventricular thrombus, and successful treatment with discontinuation of warfarin and replacement with a direct oral anticoagulant (apixaban).
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Affiliation(s)
- Georgette Nader
- Internal Medicine, Michigan State University College of Human Medicine, East Lansing, USA
- Internal Medicine, Michigan State University-Sparrow Hospital, Lansing, USA
| | - Majid Yavari
- Internal Medicine, Michigan State University College of Human Medicine, East Lansing, USA
- Internal Medicine, Michigan State University-Sparrow Hospital, Lansing, USA
| | - Anisha Timilsina
- Internal Medicine, Michigan State University College of Human Medicine, East Lansing, USA
- Internal Medicine, Michigan State University-Sparrow Hospital, Lansing, USA
| | - Sumugdha Rayamajhi
- Internal Medicine, Michigan State University College of Human Medicine, East Lansing, USA
- Internal Medicine, Michigan State University-Sparrow Hospital, Lansing, USA
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2
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Nikolova S, Milusheva M, Gledacheva V, Feizi-Dehnayebi M, Kaynarova L, Georgieva D, Delchev V, Stefanova I, Tumbarski Y, Mihaylova R, Cherneva E, Stoencheva S, Todorova M. Drug-Delivery Silver Nanoparticles: A New Perspective for Phenindione as an Anticoagulant. Biomedicines 2023; 11:2201. [PMID: 37626698 PMCID: PMC10452578 DOI: 10.3390/biomedicines11082201] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Anticoagulants prevent the blood from developing the coagulation process, which is the primary cause of death in thromboembolic illnesses. Phenindione (PID) is a well-known anticoagulant that is rarely employed because it totally prevents coagulation, which can be a life-threatening complication. The goal of the current study is to synthesize drug-loaded Ag NPs to slow down the coagulation process. Methods: A rapid synthesis and stabilization of silver nanoparticles as drug-delivery systems for phenindione (PID) were applied for the first time. Results: Several methods are used to determine the size of the resulting Ag NPs. Additionally, the drug-release capabilities of Ag NPs were established. Density functional theory (DFT) calculations were performed for the first time to indicate the nature of the interaction between PID and nanostructures. DFT findings supported that galactose-loaded nanostructure could be a proper delivery system for phenindione. The drug-loaded Ag NPs were characterized in vitro for their antimicrobial, cytotoxic, and anticoagulant activities, and ex vivo for spasmolytic activity. The obtained data confirmed the drug-release experiments. Drug-loaded Ag NPs showed that prothrombin time (PT, sec) and activated partial thromboplastin time (APTT, sec) are approximately 1.5 times longer than the normal values, while PID itself stopped coagulation at all. This can make the PID-loaded Ag NPs better therapeutic anticoagulants. PID was compared to PID-loaded Ag NPs in antimicrobial, spasmolytic activity, and cytotoxicity. All the experiments confirmed the drug-release results.
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Affiliation(s)
- Stoyanka Nikolova
- Department of Organic Chemistry, Faculty of Chemistry, University of Plovdiv, 4000 Plovdiv, Bulgaria or (M.M.); (M.T.)
| | - Miglena Milusheva
- Department of Organic Chemistry, Faculty of Chemistry, University of Plovdiv, 4000 Plovdiv, Bulgaria or (M.M.); (M.T.)
- Department of Bioorganic Chemistry, Faculty of Pharmacy, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | - Vera Gledacheva
- Department of Medical Physics and Biophysics, Faculty of Pharmacy, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria; (V.G.); (I.S.)
| | - Mehran Feizi-Dehnayebi
- Department of Chemistry, Faculty of Science, University of Sistan and Baluchestan, Zahedan P.O. Box 98135-674, Iran;
| | - Lidia Kaynarova
- Department of Analytical Chemistry and Computer Chemistry, Faculty of Chemistry, University of Plovdiv, 4000 Plovdiv, Bulgaria; (L.K.); (D.G.)
| | - Deyana Georgieva
- Department of Analytical Chemistry and Computer Chemistry, Faculty of Chemistry, University of Plovdiv, 4000 Plovdiv, Bulgaria; (L.K.); (D.G.)
| | - Vassil Delchev
- Department of Physical Chemistry, Faculty of Chemistry, University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Iliyana Stefanova
- Department of Medical Physics and Biophysics, Faculty of Pharmacy, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria; (V.G.); (I.S.)
| | - Yulian Tumbarski
- Department of Microbiology, Technological Faculty, University of Food Technologies, 4002 Plovdiv, Bulgaria;
| | - Rositsa Mihaylova
- Laboratory of Experimental Chemotherapy, Department “Pharmacology, Pharmacotherapy and Toxicology”, Faculty of Pharmacy, Medical University, 1431 Sofia, Bulgaria;
| | - Emiliya Cherneva
- Department of Chemistry, Faculty of Pharmacy, Medical University of Sofia, 2 Dunav Str., 1000 Sofia, Bulgaria;
- Organic Chemistry with Centre of Phytochemistry, Bulgarian Academy of Sciences, Acad. G. Bonchev Str., BI 9, 1113 Sofia, Bulgaria
| | - Snezhana Stoencheva
- University Hospital “Sveti Georgi” EAD, 4002 Plovdiv, Bulgaria
- Department of Clinical Laboratory, Faculty of Pharmacy, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | - Mina Todorova
- Department of Organic Chemistry, Faculty of Chemistry, University of Plovdiv, 4000 Plovdiv, Bulgaria or (M.M.); (M.T.)
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3
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Zahra T, Jamil S, Ferman H, Ravikumar Y, Voloshyna D, Shaik TA, Saleem F, Ghaffari MAZ. Warfarin-Induced Skin Necrosis in a 14-Year-Old Female: A Case Report. Cureus 2022; 14:e30354. [DOI: 10.7759/cureus.30354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/07/2022] Open
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4
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Zhang L, Truong K, Chan L, Kim J, Fernandez-Peñas P. Warfarin-induced skin necrosis after the use of an anticoagulation reversal agent. Australas J Dermatol 2022; 63:e159-e161. [PMID: 35133665 DOI: 10.1111/ajd.13801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/04/2022] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Abstract
Anticoagulant-induced skin necrosis is a rare and potentially life-threatening complication of anticoagulant therapy. The majority of cases of anticoagulant-induced skin necrosis have been attributed to warfarin, known as warfarin-induced skin necrosis (WISN). The use of anticoagulation reversal agents such as Prothrombinex-VF in the development of WISN is not a commonly documented phenomenon. The authors present a case of WISN post-recommencement of warfarin and the use of Prothrombinex-VF.
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Affiliation(s)
- Lois Zhang
- Department of Dermatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Kelvin Truong
- Department of Dermatology, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Linda Chan
- Department of Dermatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Jennifer Kim
- Department of Tissue Pathology and Diagnostic Oncology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Pablo Fernandez-Peñas
- Department of Dermatology, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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5
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Wali M, Latif MT, Lockwood M, Saeyeldin A, Borz-Baba C. Warfarin-Induced Skin Necrosis Despite Enoxaparin Bridging Therapy. Cureus 2022; 14:e20883. [PMID: 35145788 PMCID: PMC8808085 DOI: 10.7759/cureus.20883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2022] [Indexed: 11/05/2022] Open
Abstract
Skin necrosis is a rare albeit severe complication of warfarin use for anticoagulation, resulting in significant morbidity and mortality. Here, we present the case of a 58-year-old woman who developed erythema and pain in her left leg two weeks after initiation of warfarin therapy with concomitant early administration of heparin for a deep vein thrombosis and pulmonary embolism. Subsequently, the erythema progressed to skin necrosis, and a diagnosis of warfarin-induced skin necrosis (WISN) was suspected. Warfarin was discontinued, and unfractionated heparin was commenced. The simultaneous presence of eosinophilia pointed toward an associated drug-related hypersensitivity reaction. Dexamethasone was added to the medication regimen. The patient was discharged on a factor Xa inhibitor and prednisone. Recognizing WISN is crucial in patients receiving anticoagulation. The diagnosis can be particularly challenging in cases when bridging anticoagulation has been previously completed. Early diagnosis and drug discontinuation are critical to ensuring a favorable prognosis. Steroids may also play a role in the treatment of this condition if an associated drug hypersensitivity is identified.
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6
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Abstract
Anticoagulant and antiplatelet drugs target a specific portion of the coagulation cascade or the platelet activation and aggregation pathway. The primary toxicity associated with these agents is hemorrhage. Understanding the pharmacology of these drugs allows the treating clinician to choose the correct antidotal therapy. Reversal agents exist for some of these drugs; however, not all have proven patient-centered outcomes. The anticoagulants covered in this review are vitamin K antagonists, heparins, fondaparinux, hirudin derivatives, argatroban, oral factor Xa antagonists, and dabigatran. The antiplatelet agents reviewed are aspirin, adenosine diphosphate antagonists, dipyridamole, and glycoprotein IIb/IIIa antagonists. Additional notable toxicities are also reviewed.
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Affiliation(s)
- David B Liss
- Department of Emergency Medicine, Division of Medical Toxicology, Washington University in St. Louis, 660 South Euclid Avenue, CB 8072, St Louis, MO 63110, USA.
| | - Michael E Mullins
- Department of Emergency Medicine, Division of Medical Toxicology, Washington University in St. Louis, 660 South Euclid Avenue, CB 8072, St Louis, MO 63110, USA
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7
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Nsaful J, Adjei YO, Dedey F, Agboadoh N, Anyigba E, Pieterson W. Warfarin-induced skin necrosis: a rare condition. Ghana Med J 2021; 54:269-273. [PMID: 33883776 PMCID: PMC8042803 DOI: 10.4314/gmj.v54i4.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Warfarin induced skin necrosis is a rare debilitating and, in some cases, life-threatening complication. A 47-year-old male on life-long anticoagulation omits his medication and develops extensive skin necrosis of the left leg complicated by acute renal failure three days after restarting warfarin. Investigations reveal possible Protein S deficiency which is known to be a predisposing condition. Various mechanisms have been proposed as the underlying cause. He was managed on heparin, wound debridement and skin grafting. Warfarin was restarted concurrently with heparin. Knowledge of this complication will enable timely diagnosis and treatment.
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Affiliation(s)
- Josephine Nsaful
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | - Yaw Ofori Adjei
- Department of Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | - Nelson Agboadoh
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
| | - Edem Anyigba
- National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Warigbani Pieterson
- National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Accra, Ghana
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8
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Nusbaum KB, Korman AM, Tyler KH, Kaffenberger JA, Trinidad JC, Dean S, Cataland S, Kaffenberger BH. In vitro diagnostics for the medical dermatologist. Part II: Hypercoagulability tests. J Am Acad Dermatol 2021; 85:301-310. [PMID: 33852929 DOI: 10.1016/j.jaad.2021.03.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
The skin often provides initial clues of hypercoagulability with features such as livedo reticularis, livedo racemosa, retiform purpura, necrosis, and ulcerations. Because these cutaneous manifestations are nonspecific, laboratory testing is often needed to evaluate for underlying causes of hypercoagulability. Importantly, these disorders are reported to be the most common mimicker, resulting in an erroneous diagnosis of pyoderma gangrenosum. Understanding inherent properties of, and indications for, available tests is necessary for appropriate ordering and interpretation of results. Additionally, ordering of these tests in an indiscriminate manner may lead to inaccurate results, complicating the interpretation and approach to management. This second article in this continuing medical education series summarizes information on methodology, test characteristics, and limitations of several in vitro laboratory tests used for the work up of hypercoagulability and vasculopathic disease as it pertains to dermatologic disease.
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Affiliation(s)
| | - Abraham M Korman
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Kelly H Tyler
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Jessica A Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - John C Trinidad
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Steven Dean
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Spero Cataland
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio.
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9
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Fujii K, Stolt M, Komoda T, Nishikawa M. Effects of Nurse and Care Worker-led Foot-Care Program on Older People's Foot Conditions: Before and After Intervention Study. SAGE Open Nurs 2021; 7:23779608211058492. [PMID: 35155772 PMCID: PMC8832336 DOI: 10.1177/23779608211058492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 10/02/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction An increasing number of older people with frailty in Japan use geriatric day
care centers. Older people who have been certified as requiring long-term
care attend centers during the day and receive nursing care help with
bathing, excretion, meals, and functional training services. Many older
people have foot problems with need foot care by nurses and care workers
(NCWs) at geriatric day care centers. Objective This study explored the effects of NCWs’ foot-care programs on the foot
conditions of older people attending daytime services. Methods A before-after intervention study was conducted at geriatric day care centers
for older people, where the foot-care program was presented by NCWs for two
months. The foot conditions of 23 clients (8 men, 15 women, mean age = 78.6
years, standard deviation = 9.2) were assessed before and after the program.
Changes in foot condition and clients’ perceptions after the study were
analyzed through descriptive statistics, McNemar, and paired
t-tests. Results Although dramatic changes in foot conditions were not observed, some
conditions were improved or maintained. Changes were observed in mean dry
skin scores (p < .01; right foot: 1.6→1.1, left foot:
1.6→1.1), skin lesions and long nails (skin lesions R: 0.2→0.1; long nail R:
1.4→1.0, L: 1.1→0.8), and edema (R: 43.5%→39.1%, L: 52.2%→47.8%). Further,
clients started perceiving that foot health is important and discussed their
feet with staff more often. Conclusion The NCWs’ foot-care program was effective in maintaining and improving foot
health in older people and positively affected their perception of foot
care.
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Affiliation(s)
- Kashiko Fujii
- Department of Nursing, Tokyo University of Information Sciences, Chiba City, Chiba Prefecture, Japan
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Takuyuki Komoda
- Department of Plastic and Reconstructive Surgery, Toyohashi Heart Center, Toyohashi City, Aichi Prefecture, Japan
| | - Mariko Nishikawa
- Department of Nursing, University of Human Environments, Obu City, Aichi Prefecture Japan
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10
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AlQhtani A, AlSahabi A, Ashammery A. Warfarin-induced major unilateral breast necrosis in a patient with antiphospholipid syndrome: A case report. Int J Surg Case Rep 2020; 77:656-659. [PMID: 33395867 PMCID: PMC7708858 DOI: 10.1016/j.ijscr.2020.11.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 11/27/2022] Open
Abstract
Warfarin rarely causes necrosis, and antiphospholipid syndrome is a rarer cause of skin necrosis. Physicians should consider both conditions in the aetiology of skin necrosis. Management should involve stopping warfarin treatment, administering alternative medications, taking a good history, and performing proper examination, investigation, and wound management with dressings or operation using a multidisciplinary team. Wound management depends on the patient’s medical condition and considers the reconstructive ladder.
Introduction Warfarin-induced necrosis is a rare complication associated with the use of warfarin in addition to antiphospholipid syndrome. Case presentation A 50-year-old female patient with a known case of antiphospholipid syndrome started warfarin treatment for ischaemic changes in her toes and subsequently experienced warfarin-induced necrosis in her left breast. Then, warfarin treatment was suspended, and she was started on enoxaparin. Debridement was performed, and a skin graft was applied without complications. Discussion Skin necrosis has many differential diagnoses, and physicians must take a proper history and perform a physical examination with proper investigations involving a multidisciplinary team, including plastic surgery, haematology, internal medicine, and wound care specialists. Plastic surgery offers many options for reconstruction depending on the patient’s medical condition, the size of the wound and the location following the reconstructive ladder. Conclusion This case report presents a rare complication of warfarin in the context of antiphospholipid syndrome and describes the management of unilateral breast necrosis. Physicians should be highly suspicious of this condition in patients with skin necrosis who were administered warfarin or have antiphospholipid syndrome.
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Affiliation(s)
- Abdullh AlQhtani
- Plastic Surgery, General Surgery Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia.
| | - Abdulrahman AlSahabi
- Plastic Surgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahmad Ashammery
- Plastic Surgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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11
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Guzman AK, Balagula Y. Drug-induced cutaneous vasculitis and anticoagulant-related cutaneous adverse reactions: insights in pathogenesis, clinical presentation, and treatment. Clin Dermatol 2020; 38:613-628. [PMID: 33341196 DOI: 10.1016/j.clindermatol.2020.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Drug-induced vasculitis and anticoagulant-related skin reactions are commonly encountered in the inpatient and outpatient settings. The spectrum of clinical presentation is broad and ranges from focal, skin-limited disease, to more extensive cutaneous and soft tissue necrosis, to potentially fatal systemic involvement. The prompt recognition of these adverse events can have a significant impact on patient morbidity and mortality. We highlight the key features of the clinical presentation with an emphasis on primary lesion morphology, distribution, and epidemiology of purpuric drug reactions. The proposed pathophysiology, histologic findings, and therapeutic interventions of these potentially life-threatening diseases are discussed.
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Affiliation(s)
- Anthony K Guzman
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Yevgeniy Balagula
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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12
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Abstract
The color purple can be seen in several types of eruptions including inflammatory dermatoses like lichen planus, infectious dermatoses like ecthyma gangrenosum, neoplasms like Kaposi sarcoma, and vasculitis and vasculopathy. The current review focuses on the clinical appearance, pathophysiology, and treatment of several vasculitides and vasculopathies including capillaritis, cutaneous small-vessel vasculitis, immunoglobulin A (IgA) vasculitis, cryoglobulinemia, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis, polyarteritis nodosum, warfarin-induced skin necrosis, heparin-induced thrombocytopenia, purpura fulminans, antiphospholipid antibody syndrome, calciphylaxis, levamisole-induced vasculopathy, and thrombotic thrombocytopenic purpura. Dermatologists play a central role in treating patients with cutaneous vasculitis and vasculopathy and may have the opportunity to facilitate identification of systemic disease by diagnosing cutaneous vasculitis and vasculopathy.
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Affiliation(s)
- Alexa B Steuer
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Jeffrey M Cohen
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA.
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13
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Isoherranen K, O'Brien JJ, Barker J, Dissemond J, Hafner J, Jemec GBE, Kamarachev J, Läuchli S, Montero EC, Nobbe S, Sunderkötter C, Velasco ML. Atypical wounds. Best clinical practice and challenges. J Wound Care 2019; 28:S1-S92. [DOI: 10.12968/jowc.2019.28.sup6.s1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kirsi Isoherranen
- Helsinki University Central Hospital and Helsinki University, Wound Healing Centre and Dermatology Clinic, Helsinki, Finland
| | | | - Judith Barker
- Nurse Practitioner - Wound Management, Rehabilitation, Aged and Community Care., Adjunct Associate Professor, University of Canberra, Canberra, Australia
| | - Joachim Dissemond
- University Hospital of Essen, Department of Dermatology, Venerology and Allergology, Hufelandstraße 55, Essen, Germany
| | - Jürg Hafner
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Jivko Kamarachev
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Severin Läuchli
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | | | - Stephan Nobbe
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland Department of Dermatology, Cantonal Hospital of Frauenfeld, Switzerland
| | - Cord Sunderkötter
- Chair, Department of Dermatology and Venerology, University and University Hospital of Halle, Ernst-Grube-Strasse 40, Halle, Germany
| | - Mar Llamas Velasco
- Department of Dermatology, Hospital Universitario De La Princesa, Madrid, Spain
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14
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Tilton C, Livengood S, Hodges J, Marshall J. Warfarin-Induced Skin Necrosis in the Presence of Acute Hepatic Injury and May-Thurner Syndrome. Hosp Pharm 2019; 54:130-134. [PMID: 30923407 DOI: 10.1177/0018578718775322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose: The purpose of the report is to describe a patient with warfarin-induced skin necrosis in the presence of acute hepatic injury and significant risk factors for venous thromboembolism, including protein C deficiency and May-Thurner syndrome. Summary: A 44-year-old female with multiple comorbidities presented to the emergency department with a significantly elevated international normalized ratio (INR > 15.9) rapidly reversed with vitamin K and fresh frozen plasma. Due to the findings of bilateral acute on chronic deep vein thromboses (DVTs) and suspected warfarin-induced skin necrosis, a heparin infusion was initiated but later discontinued due to endogenous partial thromboplastin times (PTT) elevations despite dose reductions. Although the necrosis encompassed large areas of the fatty tissue, the depth of necrosis remained mostly superficial. Supportive care and wound management were provided following warfarin reversal; no skin grafts or amputations were performed. Conclusion: A 44-year-old female developed a complicated probable warfarin-induced skin necrosis in the setting of acute liver failure, septic shock, May-Thurner syndrome, previously failed anticoagulation, and acute deep vein thrombosis.
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Affiliation(s)
- Carrie Tilton
- Novant Health Forsyth Medical Center, Winston-Salem, NC, USA
| | | | - Jeremy Hodges
- Novant Health Forsyth Medical Center, Winston-Salem, NC, USA
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15
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Suárez-Peñaranda JM, Minasyan A, Sainz-Gaspar L, Sánchez-Aguilar MD. Resolution of acenocoumarol-associated calciphylaxis with drug withdrawal. Australas J Dermatol 2019; 60:e223-e226. [PMID: 30790279 DOI: 10.1111/ajd.13006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/15/2019] [Indexed: 12/24/2022]
Abstract
Calciphylaxis is a syndrome of cutaneous ischaemic necrosis and ulceration due to arteriolar calcification with subsequent thrombosis, which rarely presents in patients without terminal kidney disease. Recently, several reports of coumarins-associated calciphylaxis have stressed the relevance of anticoagulant therapy as an important risk factor for the development of this condition. We report five cases of acenocoumarol-associated, biopsy-proven calciphylaxis in women aged between 64 and 92 years. The drug had been prescribed for atrial fibrillation and was taken without interruption from 14 to 224 months. Lesions were present for months in all cases and were resistant to multiple therapeutic options, but they resolved only with simple wound care measures 6-14 months after changing the anticoagulant therapy.
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Affiliation(s)
- José-Manuel Suárez-Peñaranda
- Department of Pathology, Clinical Hospital and University and School of Medicine of Santiago de Compostela, Santiago de Compostela, Spain
| | - Anna Minasyan
- University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Laura Sainz-Gaspar
- Department of Dermatology, Clinical Hospital and University and School of Medicine of Santiago de Compostela, Santiago de Compostela, Spain
| | - María-Dolores Sánchez-Aguilar
- Department of Dermatology, Clinical Hospital and University and School of Medicine of Santiago de Compostela, Santiago de Compostela, Spain
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16
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Devrim T, Demirkan S. Varfarin tedavisinde nadiren gözlenen yan etki: Deri nekrozu. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.417314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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Rivaroxaban dose adjustment using thrombin generation in severe congenital protein C deficiency and warfarin-induced skin necrosis. Blood Adv 2019; 2:142-145. [PMID: 29365322 DOI: 10.1182/bloodadvances.2017012047] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/13/2017] [Indexed: 01/29/2023] Open
Abstract
Key Points
Rivaroxaban was efficacious and safe in a child with protein C deficiency to prevent the recurrence of skin necrosis or venous thrombosis. The dosage of direct oral anticoagulants in children with thrombophilia is unclear; a thrombin generation assay may be useful to adjust it.
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Abstract
Cutaneous adverse drug reactions comprise a significant proportion of all adverse drug reactions. They may mimic other dermatologic or systemic illnesses and may cause significant morbidity or mortality. Seven morphologic groups encompass the most commonly encountered cutaneous drug reaction syndromes: exanthematous (maculopapular), dermatitic/eczematous, urticarial, pustular, blistering, purpuric, and erythrodermic. Drug reactions may have significant downstream consequences for the older individual.
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19
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Fraser D, Mouton A, Serieys LEK, Cole S, Carver S, Vandewoude S, Lappin M, Riley SP, Wayne R. Genome‐wide expression reveals multiple systemic effects associated with detection of anticoagulant poisons in bobcats (
Lynx rufus
). Mol Ecol 2018; 27:1170-1187. [DOI: 10.1111/mec.14531] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/18/2017] [Accepted: 01/04/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Devaughn Fraser
- Department of Ecology and Evolutionary Biology University of California Los Angeles CA USA
| | - Alice Mouton
- Department of Ecology and Evolutionary Biology University of California Los Angeles CA USA
| | - Laurel E. K. Serieys
- Department of Ecology and Evolutionary Biology University of California Los Angeles CA USA
- Institute for Communities and Wildlife in Africa Biological Sciences University of Cape Town Cape Town South Africa
- Environmental Studies Department University of California Santa Cruz CA USA
| | - Steve Cole
- Department of Medicine University of California Los Angeles CA USA
| | - Scott Carver
- School of Biological Sciences University of Tasmania Hobart TAS Australia
| | - Sue Vandewoude
- Department of Microbiology, Immunology and Pathology Colorado State University Fort Collins CO USA
| | - Michael Lappin
- Department of Clinical Sciences Colorado State University Fort Collins CO USA
| | - Seth P.D. Riley
- National Park Service Santa Monica Mountains National Recreation Area Thousand Oaks CA USA
| | - Robert Wayne
- Department of Ecology and Evolutionary Biology University of California Los Angeles CA USA
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20
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Early Response to Warfarin Initiation and the Risk of Venous Thromboembolism After Total Joint Arthroplasty. J Am Acad Orthop Surg 2018; 26:e90-e97. [PMID: 29351137 DOI: 10.5435/jaaos-d-16-00951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Venous thromboembolism chemoprophylaxis with warfarin is common after total joint arthroplasty. Early response to warfarin initiation has been theorized to engender a transient increase in the risk of venous thromboembolism. We hypothesized that a rapid rise in the international normalized ratio is a risk factor for venous thromboembolism after total joint arthroplasty. METHODS This study was a retrospective analysis of Medicare patients undergoing elective total joint arthroplasty who were given nomogram-dosed warfarin for venous thromboembolism prophylaxis. Logistic regression was used to assess the relationship between the postoperative rate of change in the international normalized ratio and the occurrence of symptomatic venous thromboembolism within 30 days postoperatively. RESULTS The study included 948 patients (715 total knee arthroplasty, 233 total hip arthroplasty), of whom 4.4% experienced symptomatic venous thromboembolism within 30 days postoperatively. The change in the international normalized ratio from postoperative day 1 to postoperative day 2 was significantly greater in the symptomatic venous thromboembolism group compared with the group that did not have venous thromboembolism (increase of 0.70 versus 0.46; P = 0.008). Regression analysis showed that a higher rate of change in the international normalized ratio was associated with increased risk of symptomatic venous thromboembolism (odds ratio, 2.59 per unit of change in the international normalized ratio; 95% confidence interval, 1.51-4.38; P = 0.001). CONCLUSION A rapid rise in the international normalized ratio after warfarin initiation in total joint arthroplasty patients is associated with increased risk of symptomatic venous thromboembolism. This novel finding identifies a population at risk for this complication. Further study of the early effects of warfarin therapy is warranted. LEVEL OF EVIDENCE Level III.
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21
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Sklar LR, Messman A. An Atypical Case of Warfarin-Induced Skin Necrosis. Clin Pract Cases Emerg Med 2017; 1:359-361. [PMID: 29849320 PMCID: PMC5965214 DOI: 10.5811/cpcem.2017.3.33373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/08/2017] [Accepted: 03/30/2017] [Indexed: 11/11/2022] Open
Abstract
Skin necrosis is a relatively rare, potentially fatal side effect of warfarin. It is most commonly reported within 10 days of initiation of therapy in warfarin-naïve patients. We report an atypical case of warfarin-induced skin necrosis upon recommencement of warfarin in a non-naïve warfarin patient.
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Affiliation(s)
- Lindsay R Sklar
- Wayne State University, Department of Dermatology, Dearborn, Michigan
| | - Anne Messman
- Sinai-Grace Hospital, Department of Emergency Medicine, Detroit, Michigan
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22
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Aleksandrov AP, Mirkov I, Zolotarevski L, Ninkov M, Mileusnic D, Kataranovski D, Kataranovski M. Oral warfarin intake affects skin inflammatory cytokine responses in rats. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2017; 54:93-98. [PMID: 28704755 DOI: 10.1016/j.etap.2017.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/15/2017] [Accepted: 06/26/2017] [Indexed: 06/07/2023]
Abstract
Warfarin is an anticoagulant used in prevention/prophylaxis of thromboembolism. Besides the effects on coagulation, non-hemorrhagic reactions have also been documented. Although cutaneous reactions were reported in some patients, the impact on skin immunity was not explored. In the present paper, the effect of 30-day oral warfarin intake on skin cytokine responses in rats was analyzed. Increased release of inflammatory cytokines (TNF, IL-1β and IL-10) was noted by skin explants from rats which received warfarin, but without effect on IL-6. No impact on epidermal cell cytokine secretion was seen, except a tendency of an increase of IL-6 response to stimulation with microbial product lipopolysaccharide (LPS). Topical application of contact allergen dinitrochlorobenzene (DNCB) resulted in slight (numerical solely) increase of TNF release by skin explants of warfarin-treated animals, while epidermal cells responded by increased secretion of all four cytokines examined. The data presented provide new information on the potential of oral warfarin to modulate skin innate immune activity.
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Affiliation(s)
- Aleksandra Popov Aleksandrov
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, Belgrade, Serbia
| | - Ivana Mirkov
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, Belgrade, Serbia
| | | | - Marina Ninkov
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, Belgrade, Serbia
| | - Dina Mileusnic
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, Belgrade, Serbia
| | - Dragan Kataranovski
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, Belgrade, Serbia; Institute of Zoology, Faculty of Biology, University of Belgrade, Belgrade, Serbia
| | - Milena Kataranovski
- Immunotoxicology Group, Department of Ecology, Institute for Biological Research "Sinisa Stankovic", University of Belgrade, Belgrade, Serbia; Institute of Physiology and Biochemistry, Faculty of Biology, University of Belgrade, Belgrade, Serbia.
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23
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24
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Vu TT, Gooderham M. Adverse Drug Reactions and Cutaneous Manifestations Associated With Anticoagulation. J Cutan Med Surg 2017. [PMID: 28639463 DOI: 10.1177/1203475417716364] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Anticoagulants are amongst the most commonly prescribed medications worldwide. Although rare, localised and systemic drug reactions have been reported with anticoagulants that can lead to significant morbidity and mortality. Some of the first signs of drug reactions to anticoagulants are cutaneous changes that, when recognised early, can prevent significant complications. Dermatologists should be aware of these changes to make an early and accurate diagnosis. This is particularly important in instances of skin-induced necrosis caused by systemic toxicity to anticoagulants. This review discusses adverse drug reactions to the traditional anticoagulants, warfarin and heparin, and the newer direct oral anticoagulants (DOACs) such as the thrombin inhibitor, dabigatran, and the factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban. In particular, this review provides dermatologists with a framework for early diagnosis and management of patients with drug reactions to anticoagulants and alerts them to potential bleeding complications associated with minor procedures.
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Affiliation(s)
- Trang T Vu
- 1 University of Toronto, Faculty of Medicine, Toronto, ON, Canada
| | - Melinda Gooderham
- 2 Skin Centre for Dermatology, Peterborough, ON, Canada.,3 Probity Medical Research, Waterloo, ON, Canada.,4 Queen's University, Kingston, ON, Canada
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25
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Hamada T, Miyake T, Otsuka M, Iwatsuki K. Warfarin-induced skin necrosis accompanied by aggravation of vasculitis in a patient with cutaneous arteritis. Int J Dermatol 2017; 56:779-781. [PMID: 28555723 DOI: 10.1111/ijd.13656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/17/2017] [Accepted: 04/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Toshihisa Hamada
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoko Miyake
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Masaki Otsuka
- Department of Dermatology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Keiji Iwatsuki
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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26
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Shah N, Arshad HMS, Li Y, Silva R. Calciphylaxis in the Setting of Alcoholic Cirrhosis: Case Report and Literature Review. J Investig Med High Impact Case Rep 2017; 5:2324709617710039. [PMID: 28589153 PMCID: PMC5446102 DOI: 10.1177/2324709617710039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/13/2017] [Accepted: 04/15/2017] [Indexed: 12/16/2022] Open
Abstract
Calciphylaxis can be a severe life-threatening dermatologic disease that is a known complication associated with end-stage renal disease. However, multiple non-uremic etiologies that are not yet well studied can cause calciphylaxis. We report a rare care of a 40-year-old female with history of alcoholic cirrhosis without any evidence of renal dysfunction who presents with calciphylaxis.
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Affiliation(s)
- Natasha Shah
- Advocate Christ Medical Center, Oak Lawn, IL, USA
| | | | - Yanxia Li
- Advocate Christ Medical Center, Oak Lawn, IL, USA
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27
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Karimi K, Odhav A, Kollipara R, Fike J, Stanford C, Hall JC. Acute Cutaneous Necrosis: A Guide to Early Diagnosis and Treatment. J Cutan Med Surg 2017; 21:425-437. [DOI: 10.1177/1203475417708164] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Acute cutaneous necrosis is characterised by a wide range of aetiologies and is associated with significant morbidity and mortality, warranting complex considerations in management. Early recognition is imperative in diagnosis and management of sudden gangrenous changes in the skin. This review discusses major causes of cutaneous necrosis, examines the need for early assessment, and integrates techniques related to diagnosis and management. The literature, available via PubMed, on acute cutaneous necrotic syndromes was reviewed to summarise causes and synthesise appropriate treatment strategies to create a clinician’s guide in the early diagnosis and management of acute cutaneous necrosis. Highlighted in this article are key features associated with common causes of acute cutaneous necrosis: warfarin-induced skin necrosis, heparin-induced skin necrosis, calciphylaxis, pyoderma gangrenosum, embolic phenomena, purpura fulminans, brown recluse spider bite, necrotising fasciitis, ecthyma gangrenosum, antiphospholipid syndrome, hypergammaglobulinemia, and cryoglobulinemia. This review serves to increase recognition of these serious pathologies and complications, allowing for prompt diagnosis and swift limb- or life-saving management.
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Affiliation(s)
- Karen Karimi
- Texas Tech University Health Sciences Center, Department of Dermatology, Lubbock, TX, USA
| | - Ashika Odhav
- National Jewish Health, Department of Allergy and Immunology, Denver, CO, USA
| | - Ramya Kollipara
- Texas Tech University Health Sciences Center, Department of Dermatology, Lubbock, TX, USA
| | - Jesse Fike
- Texas Tech University Health Sciences Center- El Paso, Paul L. Foster School of Medicine, El Paso, TX, USA
| | - Carol Stanford
- University of Missouri Kansas City, Department of Internal Medicine, Kansas City, MO, USA
| | - John C. Hall
- University of Missouri Kansas City, Department of Internal Medicine, Kansas City, MO, USA
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28
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Wojciechowski VV, Calina D, Tsarouhas K, Pivnik AV, Sergievich AA, Kodintsev VV, Filatova EA, Ozcagli E, Docea AO, Arsene AL, Gofita E, Tsitsimpikou C, Tsatsakis AM, Golokhvast KS. A guide to acquired vitamin K coagulophathy diagnosis and treatment: the Russian perspective. ACTA ACUST UNITED AC 2017; 25:10. [PMID: 28416008 PMCID: PMC5393004 DOI: 10.1186/s40199-017-0175-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/06/2017] [Indexed: 01/05/2023]
Abstract
Abstract Physicians often come across with cases of vitamin K antagonists–dependent coagulopathy for reasons such as accidental use of the vitamin K antagonists (VKA), excessive administration of prescribed anticoagulants of indirect action or not reported administration of vitamin K antagonists due to memory impairment and/or other mental disorders, even deliberate use thereof (attempt to murder or suicide). Rodenticide-poisoning (coumarins, warfarins) via food or occupational accidents are difficult to diagnose. This article discusses different types of acquired vitamin K-dependent coagulopathy. Differential diagnosis is primarily based on patient statements before additional causes of vitamin K deficiency are explored. Even when pathological vitamin K deficiency is not determined, appropriate and urgent medical treatment is necessary: administration of fresh frozen plasma or concentrated factors of the prothrombin complex, administration of vitamin K remedies along with symptomatic therapy. With early diagnosis and prescription of appropriate therapy, prognosis is favorable. Graphical abstract Reasons for vitamin K antagonists–dependent coagulopathy cases![]()
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Affiliation(s)
- Valery V Wojciechowski
- Department of Hospital Therapy and Pharmacology, Amur State Medical Academy, 675000, Blagoveshchensk, Russia
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, Petru Rares, 200349, Craiova, Romania
| | | | - Alexander V Pivnik
- Department of Hematology-Oncology and Secondary Immunodeficient Diseases, D.D. Pletnev Moscow Clinical Research and Practical Centre of Health Department, 111123, Moscow, Russia
| | - Alexander A Sergievich
- School of Arts, Culture and Sports, Far Eastern Federal University, 690022, Vladivostok, Russia
| | - Vladimir V Kodintsev
- School of Biomedicine, Far Eastern Federal University, 690022, Vladivostok, Russia
| | - Ekaterina A Filatova
- Department of Hematology, Amur Regional Clinical Hospital, 675000, Blagoveshchensk, Russia
| | - Eren Ozcagli
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Istanbul University, Beyazit, Istanbul, 34116, Turkey
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, Petru Rares, 200349, Craiova, Romania
| | - Andreea Letitia Arsene
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, "Carol Davila" University of Medicine and Pharmacy, 6, TraianVuia Street, sector 2, 020956, Bucharest, Romania
| | - Eliza Gofita
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, Petru Rares, 200349, Craiova, Romania
| | - Christina Tsitsimpikou
- Department of Hazardous Substances, General Chemical State Laboratory of Greece, Mixtures & Articles, 16 An. Tsocha Str, Athens, 115121, Greece
| | - Aristidis M Tsatsakis
- SEC Nanotechnology, Far Eastern Federal University, 690022, Vladivostok, Russia. .,Forensic Sciences and Toxicology Department, Medical School, University of Crete, P.O. Box 1393, 71003, Heraklion, Crete, Greece. .,Scientific Educational Center of Nanotechnology, Federal Scientific Center of Hygiene, Far Eastern Federal University, F.F. Erisman, Moscow, 690950, Russian Federation.
| | - Kirill S Golokhvast
- SEC Nanotechnology, Far Eastern Federal University, 690022, Vladivostok, Russia.
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29
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Bouillon K, Bertrand M, Boudali L, Ducimetière P, Dray-Spira R, Zureik M. Short-Term Risk of Bleeding During Heparin Bridging at Initiation of Vitamin K Antagonist Therapy in More Than 90 000 Patients With Nonvalvular Atrial Fibrillation Managed in Outpatient Care. J Am Heart Assoc 2016; 5:JAHA.116.004065. [PMID: 27799233 PMCID: PMC5210354 DOI: 10.1161/jaha.116.004065] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Several studies have recently examined the risks of bleeding and of ischemic stroke and systemic embolism associated with perioperative heparin bridging anticoagulation in patients with nonvalvular atrial fibrillation. However, few studies have investigated bridging risks during vitamin K antagonist initiation in outpatient settings. Methods and Results A retrospective cohort study was conducted on individuals starting oral anticoagulation between January 2010 and November 2014 for nonvalvular atrial fibrillation managed in outpatient care and identified from French healthcare insurance. Bleeding and ischemic stroke and systemic embolism events were identified from the hospitalization database. Adjusted hazard ratios with 95% CI were estimated using Cox models during the first and 2 following months of anticoagulation. Of 90 826 individuals, 30% had bridging therapy. A total of 318 (0.35%) cases of bleeding and 151 (0.17%) ischemic stroke and systemic embolism cases were identified during the first month of follow‐up and 231 (0.31%) and 122 (0.16%) during the 2 following months, respectively. At 1 month of follow‐up, the incidence of bleeding was higher in the bridged group compared with the nonbridged group (0.47% versus 0.30%; P<0.001), and this increased risk persisted after adjustment for covariates (hazard ratio=1.60; 95% CI, 1.28–2.01). This difference disappeared after the first month of treatment (0.93; 0.70–1.23). No significant difference in the occurrence of ischemic stroke and systemic embolism was observed either at 1 month of follow‐up or later. Conclusions At vitamin K antagonist initiation for nonvalvular atrial fibrillation managed in ambulatory settings, bridging therapy is associated with a higher risk of bleeding and a similar risk of arterial thromboembolism compared with no bridging therapy.
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Affiliation(s)
- Kim Bouillon
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France
| | - Marion Bertrand
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France
| | - Lotfi Boudali
- Department of Cardiovascular, Thrombosis, Metabolism and Obesity, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France
| | | | - Rosemary Dray-Spira
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France
| | - Mahmoud Zureik
- Department of Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM), Saint-Denis, France
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30
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Tripodi A, Primignani M, Braham S, Chantarangkul V, Clerici M, Moia M, Peyvandi F. Coagulation parameters in patients with cirrhosis and portal vein thrombosis treated sequentially with low molecular weight heparin and vitamin K antagonists. Dig Liver Dis 2016; 48:1208-13. [PMID: 27470055 DOI: 10.1016/j.dld.2016.06.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 05/19/2016] [Accepted: 06/24/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS Information on coagulation for cirrhotics on anticoagulants is scanty. We investigated plasma from 23 cirrhotics treated with low-molecular-weight-heparin (LMWH) followed by vitamin K antagonists (VKA). METHODS On days 1-4 patients received full-dose LMWH. On day-5 VKA was started and LMWH was terminated when INR therapeutic-interval was reached. Blood was collected at peak and trough during LMWH, LMWH+VKA and VKA. Non-cirrhotics on VKA were included as controls. RESULTS Anti-factor Xa increased from baseline-to-peak during LMWH. During LMWH+VKA was high and reverted to zero during VKA. INR was slightly high at baseline, trough or peak during LMWH and increased to 2.2 during LMWH+VKA or VKA. Mean VKA weekly-doses for cirrhotics and controls were 28.5mg and 28.6mg. Protein C decreased upon VKA, but not to the expected extent. Endogenous-thrombin-potential (ETP) decreased from baseline (1436nMmin) to trough (1258nMmin) and peak (700nMmin) during LMWH and was further reduced during LMWH+VKA (395nMmin). CONCLUSIONS Target-INR for cirrhotics can be reached by VKA dosages similar to those for non-cirrhotics. ETP reduction parallels the effect of LMWH and/or VKA. Whether these parameters represent the antithrombotic action elicited by these drugs remains to be determined by clinical-trials and laboratory-measurements. ETP, being a global-test reflecting both pro- and anti-coagulants targeted by antithrombotic drugs, seems the candidate for these trials.
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Affiliation(s)
- Armando Tripodi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy; IRCCS Maggiore Hospital Foundation, Milano, Italy.
| | - Massimo Primignani
- First Division of Gastroenterology, Italy; IRCCS Maggiore Hospital Foundation, Milano, Italy
| | - Simon Braham
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy; IRCCS Maggiore Hospital Foundation, Milano, Italy
| | - Veena Chantarangkul
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy; IRCCS Maggiore Hospital Foundation, Milano, Italy
| | - Marigrazia Clerici
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy; IRCCS Maggiore Hospital Foundation, Milano, Italy
| | - Marco Moia
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy; IRCCS Maggiore Hospital Foundation, Milano, Italy
| | - Flora Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy; IRCCS Maggiore Hospital Foundation, Milano, Italy
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31
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Chang Y, Dabiri G, Damstetter E, Baiyee Ebot E, Powers JG, Phillips T. Coagulation disorders and their cutaneous presentations: Pathophysiology. J Am Acad Dermatol 2016; 74:783-92; quiz 793-4. [PMID: 27085225 DOI: 10.1016/j.jaad.2015.08.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 12/21/2022]
Abstract
Hypercoagulable states are inherited or acquired predispositions to venous or arterial thromboses that are best understood in the context of the coagulation cascade. Dermatologists can play a critical role in diagnosing and treating patients with hypercoagulable states because cutaneous symptoms may be a presenting manifestation, thereby reducing morbidity and mortality related to these conditions. This review focuses on the epidemiology and pathophysiology of hypercoagulable states, while the accompanying article iterates the basic clinical features, diagnostic testing, and management of patients who have these conditions.
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Affiliation(s)
- Yunyoung Chang
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Ganary Dabiri
- Department of Dermatology and Skin Surgery, Roger Williams Medical Center/Boston University School of Medicine, Providence, Rhode Island
| | - Elizabeth Damstetter
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Emily Baiyee Ebot
- Department of Hematology and Oncology, University Medical Group, Providence, Rhode Island
| | | | - Tania Phillips
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.
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32
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Gulpen AJW, Ten Cate-Hoek AJ, Ten Cate H. Upstream versus downstream thrombin inhibition. Expert Rev Cardiovasc Ther 2016; 14:1273-1282. [DOI: 10.1080/14779072.2016.1224179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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33
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Abdul-Jabar HB, Geroulakos G, Philpott N, Fareed J. Warfarin-Induced Skin Necrosis: A Case Report. Clin Appl Thromb Hemost 2016; 12:101-4. [PMID: 16444443 DOI: 10.1177/107602960601200117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Warfarin-induced skin necrosis is an unusual complication of anticoagulation therapy associated with high morbidity. A patient is presented who had protein C deficiency and in whom this complication developed twice within a short time as a result of delayed diagnosis. Early recognition of this syndrome has important implications in the treatment of such patients and may reduce the severity of complications.
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34
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Park JE, Byeon S, Kim HK, Moon SM, Moon JH, Jang KT, Lee BJ, Jang HR, Huh W, Kim DJ, Kim YG, Oh HY, Lee JE. Warfarin skin necrosis mimicking calciphylaxis in a patient with secondary hyperparathyroidism undergoing peritoneal dialysis. Kidney Res Clin Pract 2016; 35:55-8. [PMID: 27069859 PMCID: PMC4811981 DOI: 10.1016/j.krcp.2015.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/03/2015] [Accepted: 07/15/2015] [Indexed: 11/16/2022] Open
Abstract
Warfarin skin necrosis (WSN) is an infrequent complication of warfarin treatment and is characterized by painful ulcerative skin lesions that appear a few days after the start of warfarin treatment. Calciphylaxis also appears as painful skin lesions caused by tissue injury resulting from localized ischemia caused by calcification of small- to medium-sized vessels in patients with end-stage renal disease. We report on a patient who presented with painful skin ulcers on the lower extremities after the administration of warfarin after a valve operation. Calciphylaxis was considered first because of the host factors; eventually, the skin lesions were diagnosed as WSN by biopsy. The skin lesions improved after warfarin discontinuation and short-term steroid therapy. Most patients with end-stage renal disease have some form of cardiovascular disease and some require temporary or continual warfarin treatment. It is important to differentiate between WSN and calciphylaxis in patients with painful skin lesions.
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Affiliation(s)
- Jee Eun Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seonggyu Byeon
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Kyung Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Mi Moon
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hoon Moon
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kee-Taek Jang
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Jae Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Ryoun Jang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wooseong Huh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae Joong Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-Goo Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ha Young Oh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Eun Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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35
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Dabigatran in the Treatment of Warfarin-Induced Skin Necrosis: A New Hope. Case Rep Dermatol Med 2016; 2016:3121469. [PMID: 27110410 PMCID: PMC4826711 DOI: 10.1155/2016/3121469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 03/15/2016] [Indexed: 01/15/2023] Open
Abstract
Warfarin-induced skin necrosis is an infrequent and well-recognized complication of warfarin treatment. The incidence was estimated between 0.01% and 0.1% whereas a paradoxal prothrombotic state that arises from warfarin therapy seems to be responsible for this life-threatening disease. To the best of our knowledge we present the first case of an old woman diagnosed with warfarin-induced skin necrosis, in whom novel oral anticoagulants and extensive surgical debridement were combined safely with excellent results.
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36
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O'Dempsey RM, Choong AM, Patel A, Miller J, Walker PJ, Kruger A. Warfarin-induced skin necrosis following recommencement of warfarin after perioperative Prothrombinex-VF. Med J Aust 2015; 202:499-500. [PMID: 25971577 DOI: 10.5694/mja14.00052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 11/07/2014] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Amit Patel
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Jason Miller
- Professor Stuart Pegg Adult Burn Centre, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | | | - Allan Kruger
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
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Black JM, Brindle CT, Honaker JS. Differential diagnosis of suspected deep tissue injury. Int Wound J 2015; 13:531-9. [PMID: 26123043 DOI: 10.1111/iwj.12471] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 05/18/2015] [Indexed: 11/30/2022] Open
Abstract
Deep tissue injury (DTI) can be difficult to diagnose because many other skin and wound problems can appear as purple skin or rapidly appearing eschar. The diagnosis of DTI begins with a thorough history to account for times of exposure to pressure, such as 'time down' at the scene or time during which the patient was flat and could not respond. Patients with light skin tones present with classic skin discolouration of purple or maroon tissue, a defined border around the area of injury, and often surrounding erythema is evident. Persistent erythema and hyperpigmentation, rather than blanching, should be used to determine pressure injury in dark skin tone patients. Differential diagnosis includes stage 2 pressure ulcers, incontinence-associated dermatitis, skin tears, bruising, haematoma, venous engorgement, arterial insufficiency, necrotising fasciitis and terminal skin ulcers. Many skin problems can also have a purple hue or rapidly developing eschar, and a working knowledge of dermatology is needed.
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Affiliation(s)
- Joyce M Black
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Jeremy S Honaker
- Department of Dermatology, University Hospitals of Cleveland, Cleveland, OH, USA
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38
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Kim Y, Bang OY. Paradoxical Procoagulant Effect of Early Doses of Warfarin: Possible Role of Non-Vitamin K Oral Anticoagulant in Patients with Atrial Fibrillation-Related Stroke. J Stroke 2015; 17:216-8. [PMID: 26060809 PMCID: PMC4460341 DOI: 10.5853/jos.2015.17.2.216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/08/2015] [Accepted: 02/16/2015] [Indexed: 12/11/2022] Open
Affiliation(s)
- Yesel Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
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39
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Ejzenberg D, Neusquen LPDG, Rolnik DL, Lozinsky AC, Piato JRM. Breast necrosis induced by the use of coumadin: case report and review of literature. ACTA ACUST UNITED AC 2015; 13:417-9. [PMID: 26018146 PMCID: PMC4943788 DOI: 10.1590/s1679-45082015rc2829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 02/17/2014] [Indexed: 11/22/2022]
Abstract
The coumadin-induced skin necrosis is rare and occurs more frequently in the breasts, thighs and buttocks. We describe the first case of coumadin necrosis of the breast in Brazil in a 62-year-old patient.
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Affiliation(s)
- Dani Ejzenberg
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Daniel Lorber Rolnik
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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40
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Abstract
BACKGROUND Warfarin is a frequently used oral anticoagulant in the treatment and prevention of various medical conditions. One uncommon adverse effect that can occur following the initiation of therapy is warfarin-induced skin necrosis. Because it is a rare effect with an undetermined pathophysiology of disease, the treatment is not well established. CASE A 52-year-old female was prescribed warfarin and enoxaparin for a newly diagnosed deep vein thrombosis (DVT) in the left lower extremity. On day 4 of therapy, the patient had a supra-therapeutic international normalized ratio (INR), prompting the discontinuation of enoxaparin and a decrease in the warfarin dose. The patient returned to the emergency department on day 7 of treatment with a purple, cold, and extremely painful right foot with punctate areas of necrosis and petechiae proximal to the discoloration. The patient's INR was found to be 10.64. Following the diagnosis of warfarin-induced skin necrosis, the patient was administered vitamin K intravenously and fresh frozen plasma (FFP) to reverse the effects of warfarin and promote protein C and S synthesis. Once the patient's INR was no longer supratherapeutic, subcutaneous enoxaparin was re-started as treatment for the known recent DVT. The patient's necrotic foot began to improve and she was discharged home with an anticipated full recovery. CONCLUSIONS Based on the proposed pathophysiology of disease, adequate bridge therapy may decrease the likelihood of developing this life-threatening condition. Early recognition and treatment with intravenous vitamin K, FFP or 4-factor prothrombin complex concentrate, and continued wound care are essential to prevent further complications.
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Affiliation(s)
- Neda Pourdeyhimi
- Department of Pharmacy, New Hanover Regional Medical Center , Wilmington, North Carolina
| | - Zackery Bullard
- Department of Pharmacy, New Hanover Regional Medical Center , Wilmington, North Carolina
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41
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Abstract
BACKGROUND Warfarin is a frequently used oral anticoagulant in the treatment and prevention of various medical conditions. One uncommon adverse effect that can occur following the initiation of therapy is warfarin-induced skin necrosis. Because it is a rare effect with an undetermined pathophysiology of disease, the treatment is not well established. CASE A 52-year-old female was prescribed warfarin and enoxaparin for a newly diagnosed deep vein thrombosis (DVT) in the left lower extremity. On day 4 of therapy, the patient had a supra-therapeutic international normalized ratio (INR), prompting the discontinuation of enoxaparin and a decrease in the warfarin dose. The patient returned to the emergency department on day 7 of treatment with a purple, cold, and extremely painful right foot with punctate areas of necrosis and petechiae proximal to the discoloration. The patient's INR was found to be 10.64. Following the diagnosis of warfarin-induced skin necrosis, the patient was administered vitamin K intravenously and fresh frozen plasma (FFP) to reverse the effects of warfarin and promote protein C and S synthesis. Once the patient's INR was no longer supratherapeutic, subcutaneous enoxaparin was re-started as treatment for the known recent DVT. The patient's necrotic foot began to improve and she was discharged home with an anticipated full recovery. CONCLUSIONS Based on the proposed pathophysiology of disease, adequate bridge therapy may decrease the likelihood of developing this life-threatening condition. Early recognition and treatment with intravenous vitamin K, FFP or 4-factor prothrombin complex concentrate, and continued wound care are essential to prevent further complications.
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Affiliation(s)
- Neda Pourdeyhimi
- Department of Pharmacy, New Hanover Regional Medical Center, Wilmington, North Carolina.
| | - Zackery Bullard
- Department of Pharmacy, New Hanover Regional Medical Center, Wilmington, North Carolina.
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42
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Morshuis M, Özpeker C, Schulz U, Gummert J, Koster A. Herzunterstützungssysteminduzierte Störungen der Gerinnung. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2014. [DOI: 10.1007/s00398-013-1050-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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43
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Trombosis microvascular. ANGIOLOGIA 2014. [DOI: 10.1016/j.angio.2014.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
We are presenting a 72-year-old female who was admitted to hospital with deep vein thrombosis (DVT). She was known to have atrial fibrillation and was initiated on warfarin for stroke prophylaxis 3 days earlier. She was given warfarin therapy without low molecular weight heparin cover as per “slow-start regimen” protocol. The warfarin dose was increased after 3 days to achieve rapid anticoagulation, resulting in DVT in the left leg. We propose that the higher unopposed warfarin dose utilized in this case resulted in DVT. Warfarin loading doses may paradoxically result in a hypercoagulable state and potential clot formation because of significant reductions in protein C and protein S levels.
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Affiliation(s)
| | - Magda Nasher
- Southport and Ormskirk NHS Trust, Southport District General Hospital, Kew, UK
| | - Dipti Patel
- Southport and Ormskirk NHS Trust, Southport District General Hospital, Kew, UK
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45
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Wang J, Giordani M, Pereira G. Warfarin-Induced Skin Necrosis After Total Knee Arthroplasty: A Case Report. JBJS Case Connect 2014; 4:e60. [PMID: 29252499 DOI: 10.2106/jbjs.cc.m.00295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jonathan Wang
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA 95817. .
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46
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Kakagia DD, Papanas N, Karadimas E, Polychronidis A. Warfarin-induced skin necrosis. Ann Dermatol 2014; 61:325-32. [PMID: 19615543 DOI: 10.1016/j.jaad.2008.12.039] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Revised: 12/11/2008] [Accepted: 12/23/2008] [Indexed: 02/07/2023] Open
Abstract
Warfarin-induced skin necrosis is an infrequent complication occurring in individuals under warfarin treatment who have a thrombophilic history or after administration of large loading doses of warfarin particularly without simultaneous initial use of heparin. A 62-year-old lady developed skin necrosis 4 days after initiating warfarin therapy of 5 mg daily without initial co-administration of heparin. The patient had a normal clotting profile. Skin necrosis progressed to eschar formation after cessation of warfarin and heparinization stopped expanding. Warfarin was reintroduced at 2 mg daily, initially together with low molecular weight heparin. Autolytic debridement of the necrotic tissue was followed by healing of the cutaneous deficit by secondary intention. Prompt diagnosis and discontinuation of warfarin are crucial for the prognosis.
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Affiliation(s)
- Despoina D Kakagia
- Department of Surgery-Plastic Surgery, Democritus University of Thrace, Alexandoupolis, Greece
| | - Nikolaos Papanas
- Department of Internal Medicine, Democritus University of Thrace, Alexandoupolis, Greece
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47
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Tillou X, Ait-Said K, Collon S, Legal S, Desmonts A, Bensadoun H, Doerfler A. Unusual case of extensive warfarin-induced necrosis in an 84-year-old. J Am Geriatr Soc 2014; 61:2255-2257. [PMID: 24329839 DOI: 10.1111/jgs.12560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Xavier Tillou
- Urology Department, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Khalifa Ait-Said
- Urology Department, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Sylvie Collon
- Orthopedic Department, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Sophie Legal
- Urology Department, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Alexis Desmonts
- Urology Department, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Henri Bensadoun
- Urology Department, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Arnaud Doerfler
- Urology Department, Centre Hospitalier Universitaire de Caen, Caen, France
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48
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Kozac N, Schattner A. Warfarin-induced skin necrosis. J Gen Intern Med 2014; 29:248-9. [PMID: 23943419 PMCID: PMC3889929 DOI: 10.1007/s11606-013-2560-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 02/27/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Natalia Kozac
- Department of Medicine and Hematology Institute, Kaplan Medical Center, POB 1, Rehovot, 76100, Israel
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49
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Drug Reaction Patterns. Dermatopathology (Basel) 2014. [DOI: 10.1007/978-1-4471-5448-8_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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50
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Eymin G, Jaffer AK. Evidence behind quality of care measures for venous thromboembolism and atrial fibrillation. J Thromb Thrombolysis 2013; 37:87-96. [DOI: 10.1007/s11239-013-0874-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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