Coumadin-induced skin necrosis

Question 1

How long after drug initiation does Coumadin induced skin-necrosis present?

Answer 1

2-5 days (this is when protein C levels are at their lowest)

Question 2

Patients with ______ are at increased risk of Coumadin induced skin-necrosis

Answer 2

Protein C deficiency

Question 3

How does Coumadin induced skin-necrosis? What are common locations?

Answer 3

initially painful red plaques→ hemorrhagic bullae, ulcers on fatty areas

• breasts, buttocks, thighs

Question 4

What is the management for Coumadin induced skin-necrosis?

Answer 4

1. stop coumadin
2. give vitamin K, Heparin and IV protein C

Question 5

What does histology of Coumadin induced skin-necrosis show?

Answer 5

non-inflammatory thrombotic vasculopathy (multiple fibrin thrombi in dermal/SQ vessels, lacks LCV)