Warfarin-induced skin necrosis after the use of an anticoagulation reversal agent

A Rare Case of Skin Necrosis Following Extravasation of Prothrombin Complex Concentrate (PCC) Infusion During Warfarin Reversal

Warfarin-induced skin necrosis is a well-documented complication that can occur following commencement of warfarin. However, skin necrosis following extravasation of prothrombin complex concentrate (PCC) infusion is a very rare adverse event that is not commonly documented. This case illustrates the possibility of developing skin necrosis following the administration of an anticoagulation reversal agent rather than from anticoagulation itself. We report a case of a 58-year-old male who developed skin necrosis at the site of PCC infusion in the right upper extremity (RUE) for warfarin reversal of an elevated international normalized ratio (INR). The skin necrosis progressed into a full thickness chemical burn. As a result, the patient underwent allograft followed by split thickness autograft and RECELL placement. This case presentation describes the first reported case of skin necrosis following extravasation of PCC infusion during warfarin reversal.