REINSTITUTING WARFARIN IN PATIENTS WHO DEVELOP WARFARIN SKIN NECROSIS

Skin necrosis is a rare but serious complication of oral anticoagulati on with coumarin derivatives. Frequently, the necrosis can be extensiv e and may result in major morbidity and mortality. The majority of the se patients require prolonged anticoagulation for life-threatening con ditions such as deep venous thrombosis and pulmonary embolism. Resumin g oral anticoagulants in the face of skin necrosis is a difficult deci sion for both the patient and the physician. Because long-term heparin therapy is inconvenient and is associated with significant side effec ts, we reviewed the literature to find alternative treatment strategie s. A Medline search was done, and all papers published in English sinc e 1967 were reviewed. Of 58 cases with skin necrosis attributed to ora l anticoagulants, oral anticoagulation was resumed in 7 patients with no resulting adverse effects. Warfarin is the most widely used coumari n derivative in the United States. Based on our review, we make recomm endations for resuming warfarin in patients who have developed skin ne crosis when the clinical condition absolutely requires prolonged antic oagulation. (C) 1996 Wiley-Liss, Inc.