This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Robert G. C. Teepe, MD; Andre W. Broekmans, MD; Bert Jan Vermeer, MD; Annette M. Nienhuis, MD; Emil A. Loeliger, MD

Arch Dermatol. 1986;122(12):1408-1412.

Abstract
• An elderly woman who had been receiving long-term oral anticoagulant therapy developed skin and subcutaneous fat necrosis on five repeated occasions of extreme hypocoagulability, associated with coinciding periods of congestive cardiac failure. In each episode, the skin necrosis developed within days after the prothrombin time (as determined with Thrombotest) exceeded 200 s (International Normalized Ratio >5.4). Widepread thrombosis in the subcutaneous vasculature and interstitial bleeding, as observed in a skin biopsy specimen, were consistent with a diagnosis of coumarin necrosis. On two occasions, an acquired functional protein C deficiency was present. It is hypothesized that an imbalance between anticoagulant and procoagulant vitamin K-dependent factors contributed to the pathogenesis of coumarin-induced skin necrosis. This imbalance was related to repeated periods of congestive heart failure.

(Arch Dermatol 1986;122:1408-1412)

Author Affiliations
From the Departments of Dermatology (Drs Teepe and Vermeer), Hematology (Drs Broekmans and Loeliger), and Internal Medicine (Dr Nienhuis), University Hospital, Leiden, the Netherlands.

Footnotes
Accepted for publication April 23, 1986.

Reprint requests to Department of Dermatology, University Hospital, PO Box 9600, 2300 RC Leiden, the Netherlands (Dr Teepe).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Severe Adverse Cutaneous Reactions to Drugs
Roujeau and Stern
NEJM 1994;331:1272-1285.
FULL TEXT  

Coumarin-Induced Skin Necrosis
Bauer
Arch Dermatol 1993;129:766-768.
ABSTRACT  

Purple Toes and Livido Reticularis in a Patient With Cardiovascular Disease Taking Coumadin
Park et al.
Arch Dermatol 1993;129:780-780.
ABSTRACT  

Warfarin Necrosis
McKnight et al.
Arch Fam Med 1992;1:105-108.
ABSTRACT  

Purpura and Gangrene in a Septic Patient
Benson et al.
Arch Dermatol 1988;124:1851-1852.
ABSTRACT  

Purpura Fulminans: A Cutaneous Manifestation of Severe Protein C Deficiency
Auletta and Headington
Arch Dermatol 1988;124:1387-1391.
ABSTRACT  

Purpura Fulminans and Transient Protein C and S Deficiency
Dominey et al.
Arch Dermatol 1988;124:1442-1443.
ABSTRACT