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Thromb Haemost 1982; 48(03): 245-246
DOI: 10.1055/s-0038-1657270
DOI: 10.1055/s-0038-1657270
Original Article
Repeated Occurrence of Skin Necrosis Twice Following Coumarin Intake and Subsequently During Decrease of Vitamin K Dependent Coagulation Factors Associated with Cholestasis
Further Information
Publication History
Received 19 April 1982
Accepted 23 August 1982
Publication Date:
13 July 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/198203/lookinside/thumbnails/10-1055-s-0038-1657270-1.jpg)
Summary
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.
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References
- 1 Verhagen H. Local haemorrhage and necrosis of the skin and underlying tissues, during anticoagulant therapy with Dicumarol or Dicumacyl. Acta Med Scand 1954; 148: 453-467
- 2 Nalbandian RM, Mader IJ, Barrett JL, Pearce JF, Rupp EC. Petechiae, ecchymoses and necrosis of skin induced by coumarin congeners: rare, occasionally lethal complication of anticoagulation therapy. JAMA 1965; 192: 603-608
- 3 Koch-Weser J. Coumarin necrosis. (editorial notes) Ann Intern Med 1968; 68: 1365-1367
- 4 Renick AM. Anticoagulant-induced necrosis of skin and subcutaneous tissues: report of two cases and review of the English literature. South Med J 1976; 69: 775-779
- 5 Kahn S, Stern HD, Rhodes GA. Cutaneous and subcutaneous necrosis as a complication of coumarin-congener therapy. Plast Reconstr Surg 1971; 48: 160-166
- 6 Faraci PA, Deterling RA, Stein AM, Rheinlander HF, Cleveland RJ. Warfarin induced necrosis of the skin. J Surg Gyn Obstet 1978; 146: 695-700
- 7 Schleicher SM, Flicker MP. Coumarin necrosis. Arch Dermatol 1980; 116: 444-445
- 8 Nelsestuen GL, Zytkovicz TH, Howard JB. The mode of action of vitamin K: identification of γ-carboxyglutamic acid as a component of prothrombin. J Biol Chem 1974; 249: 6347-6350
- 9 Stenflo J. Vitamin K and the biosynthesis of prothrombin. IV. Isolation of peptides containing prosthetic groups from normal prothrombin and the corresponding peptides from dicoumarol-induced prothrombin. J Biol Chem 1974; 249: 5527-5535
- 10 Stenflo J. Vitamin K, prothrombin and γ-carboxyglutamic acid. Editorial. N Engl J Med 1977; 296: 624-625
- 11 Blanchard RA, Furie BC, Jorgensen M, Kruger SF, Furie B. Acquired vitamin K dependent carboxylation deficiency in liver disease. N Engl J Med 1981; 305: 242-248