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    By: Rice University PressAs a part of collection:"Images of Memorable Cases: 50 Years at the Bedside"

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    By: ConnexionsAs a part of collection:"Images of Memorable Cases: 50 Years at the Bedside"

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Images of Memorable Cases: Cases 84 & 85

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

Cases_84_85-pres1-1.jpg Cases_84_85-pres1-2.jpg
The patient on the left had a deep vein thrombosis, while the patient on the right had rheumatic mitral stenosis with atrial fibrillation.
[ Click for Diagnosis ]
84 & 85. Coumarin-induced skin necrosis
A rare and unpredictable complication of oral anticoagulation therapy, affecting women more than men. The skin necrosis typically appears on the third to fifth day of therapy, but always within the first two weeks. Frequent areas of involvement are the buttocks, thighs, and breasts. Fingers, hands, neck, and face are typically spared. The pathogenesis remains speculative, but it clearly is not dose-related. Associated congenital or acquired coagulation deficiencies have been identified in a minority of cases. Besides discontinuing anticoagulation therapy, management may include use of Vitamin K, heparin, fibrinolytic agents, or surgical debridement of gangrenous tissue. Depending on the extent and degree of necrosis, the lesions may heal on their own.
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