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CLINICAL IMAGES
Year : 2016  |  Volume : 143  |  Issue : 4  |  Page : 528-529

Warfarin induced skin necrosis


Clinical Hematology, Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India

Date of Web Publication21-Jun-2016

Correspondence Address:
Subhash Chander Varma
Clinical Hematology, Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-5916.184294

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How to cite this article:
Sahu KK, Varma SC. Warfarin induced skin necrosis. Indian J Med Res 2016;143:528-9

How to cite this URL:
Sahu KK, Varma SC. Warfarin induced skin necrosis. Indian J Med Res [serial online] 2016 [cited 2019 Sep 17];143:528-9. Available from: http://www.ijmr.org.in/text.asp?2016/143/4/528/184294



A 54 yr old woman presented to the Medicine Outpatient department, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, in January 2014 with right lower limb pain and swelling. Doppler study confirmed right femoral-popliteal vein deep venous thrombosis (DVT). She was given injection of low-molecular weight heparin (LMWH) 0.6 ml twice daily and warfarin 3 mg once daily. However, due to unavailability she took only four injections of LMWH but continued warfarin. On the 10th day, she came again with complaints of skin discolouration of lower limbs and abdomen [Figure 1]. Diagnosis of warfarin related necrosis was made and she was given intravenouly (iv) vitamin K injection and fresh frozen plasma due to prolonged international normalized ratio (INR, 7.05). Once INR was normalized, LMWH injections were restarted. In view of chances of irregular follow up due to distant home place, she was referred to the local doctor for further care. Thereafter, she successfully received LMWH injections followed by warfarin for the next six months with resolution of skin necrosis. DVT is a common but challenging encounter in clinics. Compliance, dose adjustment, avoidance of vitamin K containing food items are mandatory requirements for the successful treatment. However, in reality many patients default during follow up leading to complications.
Figure 1: Well defined violaceous patches (thick black arrow) with central bullae formation (thin black arrow). The lesion is surrounded with peripehral rim of erythmatous patch. (A) Left thigh, (B) Right thigh, (C) Abdomen, (D) Left foot

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Conflicts of Interest:

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