Warfarin-induced skin necrosis

Background

• Differing half-lives of Vitamin-K dependent coagulation factors leads to relative protein C deficiency initially--> hypercoagulability
• Onset usually in first week of starting warfarin

Clinical Features

• Painful, red lesions over extremities, trunk, penis
• Start with erythematous macule--> edema--> central purpuric zones --> necrosis

Management

• Stop warfarin
• Low molecular weight heparin or unfractionated heparin