warfarin and Breast-Diseases

A case report of coumadin-induced skin necrosis (CISN) is presented, followed by a topic review of CISN, which reviews presentation, pathophysiology, differential diagnosis, prevention, and management of this disorder. The prevalence of CISN is low (0.01%-0.1% of patients receiving coumadin). However, of those affected, over 50% required some form of surgical debridement or reconstruction. Although skin necrosis secondary to coumadin therapy is rare, it is essential for plastic surgeons to be aware of this clinical entity in order to make the correct diagnosis and provide appropriate treatment.

Topics: Anticoagulants; Breast Diseases; Diagnosis, Differential; Female; Humans; Middle Aged; Necrosis; Warfarin

Breast and nipple skin is commonly affected by various inflammatory and neoplastic processes. Despite this fact, many physicians are unaware of the spectrum of diseases that can involve this area. Because breast and nipple skin represents a cosmetically, sexually, and functionally important entity to most patients, awareness of these disease entities is invaluable. This article reviews the normal anatomy of the breast, cutaneous manifestations of neoplastic processes that can present in these areas, and common inflammatory diseases of the breast and nipple skin.

Topics: Anticoagulants; Breast Diseases; Breast Neoplasms; Dermatitis; Female; Hidradenitis Suppurativa; Humans; Mastitis; Necrosis; Nipples; Panniculitis, Lupus Erythematosus; Scleroderma, Localized; Warfarin

Two cases of necrosis of skin and subcutaneous tissues in patients taking oral anticoagulants are reported, and the English literature is reviewed. The mechanism of coumarin necrosis remains unknown. Most patients are women and the lesions are most common on the abdomen, buttocks, thighs, and breasts. Simple mastectomy is the usual treatment for a breast lesion. Although some cases have been reported in which the skin lesion has healed despite continued anticoagulant therapy, curtailing its use is recommended. Heparin has not been associated with skin necrosis, however, and may be desirable if continued anticoagulant treatment is necessary.

Topics: Anticoagulants; Breast Diseases; Coumarins; Female; Heparin; Humans; Male; Mastectomy; Middle Aged; Necrosis; Skin Diseases; Warfarin

Topics: Aged; Anticoagulants; Atrial Fibrillation; Blood Coagulation Factors; Breast Diseases; Computed Tomography Angiography; Female; Hemorrhage; Humans; Vitamin K 3; Warfarin

Matrix gla protein is a vitamin K-dependent inhibitor of medial arterial calcification whose synthesis and activity are blocked by warfarin. Warfarin induces arterial calcification in experimental models, but whether this occurs in humans is unclear. This was addressed by examining breast arterial calcification, which is exclusively medial and easily identified on mammograms.. Screening mammograms from women with current, past, or future warfarin use were examined for the presence of arterial calcification and compared with mammograms obtained in untreated women matched for age and diabetes mellitus. Women with a serum creatinine >2.0 mg/dL or a history of end-stage renal disease were excluded. In 451 women with mammograms performed after ≥1 month of warfarin therapy, the prevalence of arterial calcification was 50% greater than in 451 untreated women (39.0% versus 25.9%; P<0.0001). However, in 159 mammograms performed before warfarin therapy, the prevalence of arterial calcification was not increased (26.4% versus 25.8%). The increased prevalence varied with duration of treatment, from 25.0% for <1 year to 74.4% for >5 years. In a multivariable logistic model, only age and duration of warfarin, but not the period of time after stopping warfarin, were significant determinants of arterial calcification in women with current or past warfarin use.. The prevalence of breast arterial calcification is increased in women with current or past warfarin use independent of other risk factors and conditions predating warfarin use. This effect appears to be cumulative and may be irreversible.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Breast Diseases; Case-Control Studies; Chi-Square Distribution; Drug Administration Schedule; Female; Georgia; Humans; Logistic Models; Mammography; Middle Aged; Multivariate Analysis; Prevalence; Risk Factors; Time Factors; Vascular Calcification; Warfarin

Topics: Anticoagulants; Breast Diseases; Female; Humans; Vascular Calcification; Warfarin

Skin necrosis is an uncommon complication of warfarin (Coumadin; Dupont Pharma, Wilmington, DE) therapy. The presentation may mimic other disorders. This article reports a case of a 72-year-old woman who presented to the emergency department complaining of swelling and ecchymosis to her left breast and right foot. The patient had been hospitalized for coronary artery bypass grafting, and had been discharged from the hospital earlier that day. This article reviews the pathophysiology and clinical features of warfarin-induced skin necrosis.

Topics: Aged; Anticoagulants; Breast Diseases; Diagnosis, Differential; Emergency Medical Services; Female; Foot Dermatoses; Humans; Necrosis; Skin; Warfarin

Topics: Aged; Anticoagulants; Breast Diseases; Female; Hemorrhage; Humans; Practice Guidelines as Topic; Warfarin

Topics: Adult; Breast Diseases; Fat Necrosis; Female; Humans; Mammography; Warfarin

Two patients had breast necrosis after sodium warfarin (Coumadin) therapy. This well recognized, but rare, complication of anticoagulation therapy also occurs in other areas of the body. The cause is not known. We present these cases and discuss the literature.

Topics: Aged; Breast; Breast Diseases; Dose-Response Relationship, Drug; Female; Humans; Lung Diseases, Obstructive; Middle Aged; Necrosis; Prothrombin Time; Pulmonary Embolism; Warfarin

A case of coumadin necrosis of the breast is presented. Most patients with this entity are obese, middle-aged females who have been treated with oral anticoagulants for three to five days for thrombophlebitis or peripheral arterial embolization. The key to therapy is early diagnosis and clinical differentiation from subcutaneous hemorrhage--a disease which is self-limited, nonprogressive, and treatable when anticoagulant therapy is either discontinued or reversed with vitamin K. Surgical debridement or simple mastectomy is generally necessary in those cases where necrosis is present.

Topics: Breast Diseases; Female; Humans; Middle Aged; Necrosis; Thromboembolism; Warfarin

A case of ovarian carcinoma with bilateral metastases to the breasts is presented. This is the first report of simultaneous involvement of both breasts presenting as an inflammatory tumor. Axillary lymph node enlargement preceded breast involvement. The related literature is reviewed briefly, and the unpredictable invasiveness of malignant neoplasms is emphasized.

Topics: Adenocarcinoma, Papillary; Breast Diseases; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Middle Aged; Necrosis; Ovarian Neoplasms; Warfarin

Sodium warfarin was administered to a 59-year-old woman with congestive cardiac failure and deep vein thrombosis. After 3 days of therapy the nipple and areola of the left breast became inflamed; the entire breast then became necrotic. Gangrene spread and a simple mastectomy was performed. The patient died from pulmonary embolism 1 day after operation. Histologic examination of the breast revealed thrombi in some of the arteries and veins. The etiology of this condition is obscure, and there is no known way of preventing or effectively treating the condition. Simple mastectomy or more conservative local excision recommended.

Topics: Breast Diseases; Female; Gangrene; Humans; Middle Aged; Skin Diseases; Warfarin

Topics: Breast Diseases; Female; Heparin; Humans; Middle Aged; Necrosis; Phenindione; Warfarin

Topics: Anemia, Hemolytic; Breast Diseases; Disseminated Intravascular Coagulation; Female; Fibrin; Gangrene; Humans; Middle Aged; Necrosis; Thrombophlebitis; Warfarin

Topics: Breast Diseases; Female; Hemorrhage; Humans; Middle Aged; Warfarin

Topics: Aged; Breast Diseases; Female; Humans; Necrosis; Pulmonary Embolism; Warfarin

Topics: Aged; Breast Diseases; Buttocks; Female; Humans; Necrosis; Thrombophlebitis; Warfarin

Topics: Aged; Anticoagulants; Arteriosclerosis; Arthritis; Breast Diseases; Female; Gangrene; Humans; Hypertension; Mastectomy; Middle Aged; Necrosis; Penicillins; Postoperative Complications; Thrombophlebitis; Warfarin

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

Topics: Aged; Anticoagulants; Blood Transfusion; Breast Diseases; Buttocks; Coumarins; Diagnosis, Differential; Female; Hemorrhage; Humans; Male; Middle Aged; Necrosis; Thrombophlebitis; Vitamin K; Warfarin

Topics: Aged; Breast Diseases; Female; Gangrene; Hemorrhage; Heparin; Humans; Middle Aged; Phenindione; Pulmonary Embolism; Thrombophlebitis; Warfarin