phenprocoumon and Skin-Diseases

To date, there is still a debate how to deal with patients receiving antithrombotic agents prior to surgical procedures on the skin.. To prospectively assess complications after dermatosurgical interventions, especially bleeding, depending on anticoagulation therapy.. Patients underwent surgery consecutively as scheduled, without randomization, whether or not they were currently taking anticoagulants. Nine institutions of the DESSI (DErmatoSurgical Study Initiative) working group documented patient data prospectively on a standardized study sheet prior to and after 9154 dermatosurgical interventions.. Bleeding complications were observed in 7.14% of cases (654/9154 surgeries). A severe bleed requiring intervention by a physician occurred in 83 surgeries (0.91%). In multivariate analysis, INR, length of the defect, perioperative antibiotic treatment, current treatment with anticoagulation therapy, age and surgery on hidradenitis suppurativa/acne inversa (HS/AI) were significant parameters independently influencing the risk of bleeding. Discontinuation of phenprocoumon therapy and subsequent switching to low molecular weight heparin was associated with the highest risk of bleeding (9.26%).. Bleeding complications in skin surgery are generally rare. Even if slightly increased complication rates are found in patients taking anticoagulants during skin surgery, platelet inhibitors should not be stopped prior to surgery. If a surgical procedure in patients on a combination therapy of 2 or more antiplatelet cannot be postponed, it should be conducted with the patient remaining on combination therapy. Discontinuation of DOACs is recommended 24 h prior to surgery. Bridging of phenprocoumon should be terminated. In patients with a bleeding history, the INR value should be within the therapeutic range.

Topics: Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anticoagulants; Dermatologic Surgical Procedures; Female; Heparin; Hidradenitis Suppurativa; Humans; International Normalized Ratio; Male; Middle Aged; Phenprocoumon; Postoperative Hemorrhage; Prospective Studies; Risk Assessment; Risk Factors; Skin Diseases; Surgical Wound

Topics: Aged, 80 and over; Airway Obstruction; Anticoagulants; Atrial Fibrillation; Cough; Deglutition Disorders; Drug Overdose; Hematoma; Humans; Male; Neck; Phenprocoumon; Prothrombin Time; Skin Diseases; Venous Insufficiency

Topics: Abdominal Pain; Aged; Drug Overdose; Female; Gastritis; Gastrointestinal Hemorrhage; Hematoma; Humans; Phenprocoumon; Self Medication; Skin Diseases; Vitamin K Deficiency

In three patients painful reddening of a well-circumscribed area of the skin occurred within five days of starting anticoagulant treatment with phenprocoumon (Marcumar), and within a short time it developed into a full-blown picture of coumarin necrosis. The indication for phenprocoumon was, in the first patient (a 29-year-old mother lying-in after her second child had been born) an increased platelet count and the presence of high risk factors for thromboembolism. In the second patient (25-year-old man) and the third one (45-year-old woman) it was secondary prophylaxis after pulmonary embolus and deep-vein thrombosis, respectively. All three patients were very obese and had a drug allergy, as well as other allergies (bronchial asthma in Cases 1 and 2; allergic rhinitis in Case 3). Phenprocoumon was at once discontinued in all three patients and low-dose heparin administration (Cases 1 and 3) or dextran infusion (Case 2: heparin intolerance) started. All three needed excision of the necrotic tissue with grafting to the skin defect. The coexistence of obesity and allergic diathesis may thus present an especially high risk for coumarin necrosis.

Topics: Adult; Coumarins; Drug Hypersensitivity; Drug Therapy, Combination; Female; Heparin; Humans; Middle Aged; Necrosis; Obesity; Phenprocoumon; Pulmonary Embolism; Risk Factors; Skin Diseases; Thrombophlebitis; Time Factors

Topics: 4-Hydroxycoumarins; Adult; Antithrombin III Deficiency; Female; Hemorrhage; Humans; Necrosis; Phenprocoumon; Skin Diseases; Thrombophlebitis; Toes

Successful prevention of the progression of incipient hemorrhagic skin necrosis by timely administration of vitamin K1 in a woman treated with phenprocoumon is presented. From a critical review of the literature strong evidence emerges that coumarin necrosis does only occur in cases with severe initial drug induced hypocoagulability. Non- recognition thusfar of its importance is due to insufficient knowledge of the biological activities of thromboplastin preparations presently used in the laboratory control of oral anticoagulation. All well documented cases with apparently adequate Quick values were monitored with Faktor VIII insensitive thromboplastin. Therefore, such preparations should no longer be used in anticoagulant control.

Topics: 4-Hydroxycoumarins; Female; Hemorrhage; Humans; Middle Aged; Necrosis; Phenprocoumon; Skin; Skin Diseases; Thromboplastin; Vitamin K 1