WARFARIN-INDUCED NECROSIS OF THE SKIN

Warfarin (Coumadin)-induced necrosis of the skin is an unusual conditi on associated with the administration of warfarin. The necrotic lesion s appear suddenly and are extremely painful. Single dr multiple lesion s develop in a distinct pattern. A hypercoagulable state created early in the course of warfarin administration is most likely responsible f or warfarin-associated necrosis. Functional and inherited low levels o f proteins C and S are found in some patients. The differential diagno sis of warfarin necrosis is of interest to the plastic surgeon. The co ndition may mimic purpura fulminans, necrotizing fasciitis, microembol ization, breast cancer, and decubitus ulcers. Early recognition and tr eatment are essential to avoid significant and prolonged morbidity. Mo rtality has also been reported. We present 2 cases of warfarin-induced necrosis and a review of the literature.