acenocoumarol and Necrosis

Cutaneous necrosis is an infrequent but well-documented complication of oral anticoagulants. In the pathogenesis of cutaneous necrosis induced by oral anticoagulants recent hypotheses favour the combined role of local factors and a transient unbalance of coagulation mechanisms leading to an hypercoagulable state. There exists a genetic factor that determines a decreased level of two vitamin-K dependent glycoproteins, namely protein C and protein S. We present the case of an obese woman that developed an extensive cutaneous necrosis while receiving acenocoumarol for a deep venous thrombosis. She had an heterozygous deficit for protein C. The histopathologic findings of vessel thrombi and red blood cell extravasation were consistent with the clinical picture. A biopsy specimen taken from an initial lesion disclosed images of leucocytoclastic vasculitis. We reviewed the literature focusing on the pathogenesis and the histopathology of the disease.

Topics: Acenocoumarol; Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Female; Humans; Necrosis; Protein C Deficiency; Skin; Vasculitis, Leukocytoclastic, Cutaneous

We describe a 57-year-old woman with homozygous protein C deficiency and mild thrombotic manifestations consisting of three spontaneous distal deep vein thromboses occurring after the age of 45. Previous surgery and pregnancies had been uneventful. Low but detectable protein C antigen and activity levels (both 20%) were discovered on the occasion of skin necrosis induced by oral anticoagulation. This therapy was interrupted because of skin necrosis and several episodes of disseminated intravascular coagulation (DIC) at the initiation of treatment despite a cautious protocol. No recurrent thromboembolic event has occurred in our patient using prophylactic doses of low molecular weight heparin for 24 months. New therapeutic approaches might be the administration of low molecular weight heparin or oral anticoagulation associated with protein C replacement in the induction period. This case reflects the variability of expression of protein C deficiency as well as the potential hazards of antivitamin K anticoagulation in this disorder.

Topics: Acenocoumarol; Administration, Oral; Age Factors; Blood Coagulation Disorders; Contraindications; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Female; Genetic Predisposition to Disease; Heparin; Homozygote; Humans; Middle Aged; Necrosis; Protein C Deficiency; Skin; Skin Diseases; Thrombophlebitis; Warfarin

Topics: Acenocoumarol; Anti-Bacterial Agents; Anticoagulants; Brain Ischemia; Dermatologic Surgical Procedures; Female; Heparin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Necrosis; Skin; Stroke; Tomography, X-Ray Computed; Treatment Outcome; Upper Extremity

Vitamin K antagonists are widely used in thromboembolic diseases. Hemorrhagic complications related to drug overdose represent their main side effect. We report a rare side effect, a severe and unexpected type of skin vasculitis - necrotic leg ulcer - induced by vitamin K antagonist.. A 63-year-old female with a history of diabetes developed hyperalgesic necrotic ulcerations on the lower limbs one month after starting an acenocoumarol-based treatment for ischemic heart disease. Histological examination revealed lymphocytic vasculitis with fibrinoid necrosis. Etiological explorations searching for vasculitis were negative. In the absence of a precise etiology, drug-induced ulcer was suspected. Low molecular weight heparin was prescribed to replace acenocoumarol. The lesions slowly resolved with topical treatment.. The chronological criteria and the negativity of etiological explorations allowed the diagnosis of vitamin K antagonist-induced necrotic skin ulcer. Clinicians should be aware of this rare complication induced by oral anticoagulants because of its practical therapeutic implications. This is the first case of necrotic leg ulcer induced by acenocoumarol corresponding histologically to necrotising lymphocytic vasculitis.

Topics: Acenocoumarol; Anticoagulants; Diabetes Mellitus, Type 2; Drug Substitution; Female; Heparin, Low-Molecular-Weight; Humans; Hyperalgesia; Leg Ulcer; Middle Aged; Necrosis; Vasculitis; Vitamin K

Venous thromboembolism is an important cause for maternal morbidity and mortality in postpartum period. Though catheter-directed thrombolysis (CDT) is now considered as a safe and effective therapy for the management of deep venous thrombosis (DVT) but still it is not indicated in postpartum DVT. We are presenting a case of 22-year-old female patient who presented with post-partum lower limb DVT and managed successfully with CDT by using injection streptokinase and temporary inferior vena caval filter was inserted as prophylactic for pulmonary embolism as she had extensive DVT extending into inferior vena cava (IVC). During follow-up, she developed large skin necrosis in left lower limb which was managed by adding injection low-molecular-weight heparin. IVC filter also could not be retrieved even after trying all manoeuvres during follow-up after 2 weeks.

Topics: Acenocoumarol; Anticoagulants; Catheterization, Peripheral; Female; Fibrinolytic Agents; Humans; Lower Extremity; Necrosis; Puerperal Disorders; Skin; Streptokinase; Vena Cava Filters; Venous Thrombosis; Young Adult

Chronic thromboembolic pulmonary hypertension (CTEPH) is a chronic progressive disease of pulmonary circulation characterised by indistinct ethiopathogenesis. We present a case of a 50 year-old male with thrombophilia of unknown origin leading to the formation of multiple thrombi within venous circulation followed by episodes of acute pulmonary embolism resulting ultimately in acute heart failure in the course of developing CTEPH. Unfortunately, despite the wide range of haemostasis laboratory tests we were not able to define the type of coagulation abnormality. Owing to the efficient cooperation between cardiologists and cardiosurgeons it was possible to save patient's life.

Topics: Acenocoumarol; Anticoagulants; Cardiac Surgical Procedures; Coronary Thrombosis; Echocardiography, Doppler; Humans; Hypertension, Pulmonary; Intestine, Small; Male; Middle Aged; Myocardial Infarction; Necrosis; Pulmonary Embolism; Stroke; Time Factors; Treatment Outcome; Warfarin

Vitamin K antagonists (VKAs) are widely used in thromboembolic diseases. We report five cases of necrotic leg ulcers having a particularly severe course and in which withdrawal of VKA treatment alone enabled healing.. Five patients presented with necrotic leg ulcers clinically evocative of necrotic angiodermatitis or vasculitis. Histological features were variable, including inconstantly inflammatory lesions (leukocytoclastic vasculitis) and microthrombosis. None of the patients had laboratory signs of autoimmune disease. Healing occurred in all patients only after withdrawal of VKA therapy (fluindione or acenocoumarol). Associated vascular diseases included superficial venous, distal arterial insufficiency and postphlebitic disease. In three cases, thrombotic factors were observed: hyperhomocysteinaemia or heterozygous Factor V Leiden mutation.. Although the causative role of VKAs is based solely on chronological criteria, this potential side effect deserves publication because of its practical therapeutic consequences. The physiopathological mechanisms accounting for the role of VKAs, including immunoallergic phenomena and, above all, microcirculatory thrombotic processes, are hypothetical and not universally accepted.

Topics: Acenocoumarol; Activated Protein C Resistance; Aged; Aged, 80 and over; Anticoagulants; Diabetic Angiopathies; Factor V; Female; Humans; Hyperhomocysteinemia; Leg Ulcer; Male; Necrosis; Phenindione; Polyarteritis Nodosa; Postoperative Complications; Purpura; Thrombophilia; Varicose Ulcer; Vasculitis, Leukocytoclastic, Cutaneous; Vitamin K

Topics: Acenocoumarol; Anticoagulants; Atrial Fibrillation; Fatal Outcome; Female; Humans; Liver Cirrhosis, Alcoholic; Middle Aged; Necrosis; Protein C Deficiency; Skin Diseases

The authors describe the combined occurrence of heparin-induced thrombocytopenia and cumarin-induced skin necrosis, a rare condition that has not yet been reported in Hungary. The 69-year-old woman had received prophylactic heparin treatment prior to total hip arthroplasty. The first complication that the anticoagulant therapy brought about was serious thrombocytopenia paradoxically associated not with bleeding but with deep vein thrombosis. The latter necessitated coumarin therapy which resulted in severe skin necrosis.

Topics: Acenocoumarol; Aged; Female; Heparin; Hip Prosthesis; Humans; Necrosis; Postoperative Complications; Preoperative Care; Skin; Thrombocytopenia; Thrombophlebitis

Topics: Acenocoumarol; Combined Modality Therapy; Female; Heparin; Humans; Middle Aged; Necrosis; Partial Thromboplastin Time; Plasma; Protein C; Protein C Deficiency; Skin; Thrombophlebitis; Warfarin

Topics: Acenocoumarol; Aged; Biopsy; Drug Eruptions; Erythema; Hemorrhage; Humans; Male; Necrosis; Skin

Topics: Acenocoumarol; Adult; Humans; Leg Ulcer; Male; Necrosis; Protein C Deficiency; Skin

A kindred with Type I protein S deficiency is described in which the index case developed skin necrosis during induction of oral anticoagulant therapy for deep venous thrombosis. Two other family members with protein S deficiency have been detected, and demonstrate the clinical variability of this condition.

Topics: Acenocoumarol; Adult; Female; Heparin; Humans; Male; Necrosis; Partial Thromboplastin Time; Pregnancy; Protein C; Skin; Thrombophlebitis; Transcription Factors; Transcription Factors, General; Transcriptional Elongation Factors

Topics: Acenocoumarol; Aged; Female; Humans; Male; Middle Aged; Myocardial Infarction; Necrosis; Pulmonary Embolism

Topics: Acenocoumarol; Adenocarcinoma; Adult; Anticoagulants; Bronchial Neoplasms; Female; Humans; Leg; Necrosis; Thrombophlebitis

A female patient is described who developed skin and subcutaneous fat necrosis on two occasions after intake of acenocoumarol. Several months later identical skin changes occurred during an episode of cholestasis associated with a prolongation of the prothrombin time to an extent comparable with therapeutic anticoagulation; intake of oral anticoagulants could be excluded. This association gives new insights in the pathogenetic mechanisms responsible for the so-called coumarin necrosis and indicates that it may be not due to drug toxicity or allergy.

Topics: Acenocoumarol; Adipose Tissue; Adult; Blood Coagulation Factors; Cholestasis; Drug Therapy, Combination; Female; Heparin; Humans; Necrosis; Recurrence; Skin Diseases; Thrombophlebitis; Vitamin K

Topics: Abdomen; Acenocoumarol; Buttocks; Female; Humans; Leg; Male; Middle Aged; Necrosis; Thrombophlebitis

Topics: Acenocoumarol; Anticoagulants; Humans; Lasers; Necrosis

Topics: Acenocoumarol; Aged; Female; Humans; Necrosis; Pulmonary Embolism; Skin Diseases; Sodium Salicylate

A patient with viral hepatitis in the third trimester of pregnancy is described. She developed acute hepatic failure in the postpartum period which was associated with evidence of intravascular coagulation. Following therapy with heparin and fresh-frozen plasma, the patient made a dramatic recovery. Hepatitis developed during the puerperium may predispose to pathological intravascular coagulation and hepatocellular necrosis may thereby be perpetuated.

Topics: Acenocoumarol; Acute Disease; Adult; Alanine Transaminase; Alkaline Phosphatase; Bilirubin; Blood Platelets; Disseminated Intravascular Coagulation; Female; Fibrin; Fibrinogen; Heparin; Hepatitis A; Humans; Necrosis; Plasma; Postpartum Period; Pregnancy; Pregnancy Complications, Infectious; Time Factors

Topics: Acenocoumarol; Aged; Breast Diseases; Buttocks; Female; Humans; Middle Aged; Necrosis; Skin; Thigh

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Breast Diseases; Coumarins; Diabetes Complications; Female; Foot Diseases; Hemorrhage; Humans; Intracranial Embolism and Thrombosis; Middle Aged; Necrosis; Obesity; Pulmonary Embolism; Thromboembolism; Thrombophlebitis; Thrombosis

Topics: Acenocoumarol; Breast Diseases; Female; Humans; Middle Aged; Necrosis; Skin; Skin Diseases; Thrombophlebitis

Topics: Acenocoumarol; Breast Diseases; Female; Humans; Middle Aged; Necrosis

Topics: Acenocoumarol; Anticoagulants; Coumarins; Dicumarol; Drug Therapy; Ecchymosis; Ethyl Biscoumacetate; Gangrene; Necrosis; Phenindione; Pulmonary Embolism; Purpura; Skin Diseases; Thrombophlebitis; Toxicology; Warfarin

Topics: Acenocoumarol; Female; Humans; Middle Aged; Necrosis; Skin Diseases

Topics: Acenocoumarol; Anticoagulants; Coumarins; Dermatology; Dicumarol; Estrogens; Ethyl Biscoumacetate; Heparin; Iatrogenic Disease; Necrosis; Toxicology

Topics: Acenocoumarol; Hematoma; Humans; Necrosis; Thrombosis

Topics: Acenocoumarol; Anticoagulants; Dermatology; Heparin; Humans; Necrosis; Pulmonary Embolism; Toxicology