SKIN NECROSIS - A PARADOXICAL COMPLICATION OF ANTICOAGULATION

Skin necrosis is an uncommon complication associated with coumarin or heparin therapy. The gross appearance and histology of the lesions - a paradoxical thrombosis of skin vessels - are identical. However, skin necrosis is the symptom of two different disorders. Coumarin necrosis may be related to reduced levels of protein C or S during the early s tages of anticoagulation. It is possible to continue warfarin therapy, simultaneously with heparin, if further anticoagulation is still requ ired. In contrast, heparin necrosis is a manifestation of the potentia lly fatal heparin-associated thrombocytopenia and thrombosis syndrome (HATT). Immediate discontinuation of heparin is mandatory.