Recurrent warfarin-induced skin necrosis in kindreds with protein S deficiency

Warfarin-induced skin necrosis is a rare complication of anticoagulant trea tment. The incidence of this complication is undetermined, but it has been estimated to occur between 1:100 and 1:10,000 of patients treated with anti coagulants. Coumarin skin necrosis occurs almost exclusively in patients wi th venous thrombosis between the 3rd and 10th day after beginning anticoagu lation, Although protein C deficiency is the most common underlying hyperco agulable state reportedly associated with warfarin skin necrosis, very few cases have been linked to congenital protein S deficiency. This article add resses the association of hereditary protein S deficiency and warfarin skin necrosis, and provides suggestions for management.