TREATMENT OF COUMARIN-INDUCED SKIN NECROSIS WITH A MONOCLONAL-ANTIBODY PURIFIED PROTEIN-C CONCENTRATE

Background and Design.-Protein C is a vitamin K-dependent plasma prote in that is converted to the serine protease activated protein C by the thrombin-thrombomodulin complex. Activated protein C functions as a n atural anticoagulant by inactivating the cofactors of the coagulation cascade, factors Va and VIIIa. Coumarin (warfarin)-induced skin necros is is thought to be due to a rapid elimination of protein C relative t o other vitamin K-dependent factors during the initial phase of oral a nticoagulation. We have used a highly purified protein C concentrate t o treat a patient with acquired protein C deficiency who developed ski n necrosis during the initial phase of oral anticoagulant therapy. Obs ervations and Conclusions.-During protein C concentrate therapy, no fu rther skin lesions appeared, and the healing process of necrotic areas was facilitated. Replacement therapy with protein C concentrate appea rs to be safe and effective as an adjunctive treatment for coumarin-in duced skin necrosis.