Alica Slobodová, Marcela Danková, Veronika Pokorná, Peter Švarc, Peter Ponťuch
Warfarin-induced skin necrosis (WISN) is a serious and life-threatening complication of oral anticoagulation therapy.
The case of a 31-year old woman treated for deep venous thrombosis and pulmonary embolism is presented. Few days
after concomitant treatment with low molecular weight heparin and warfarin was initiated, skin necrosis developed.
Pathogenesis of WISN is still not sufficiently clarified; it is explained by an imbalance in coagulation and anticoagulation
factors following initiation of coumarin therapy. Case history and skin distribution in conjunction with histological
findings help to differentiate coumarin necrosis from other conditions. The aim of this work is to present this rare complication,
to provide guidance on the clinical course, local manifestations, histopathological evidence, changes in laboratory
parameters, treatment options and prevention. Obtained data could be beneficial in further management of patients
with warfarin-induced skin necrosis who require lifelong anticoagulation therapy.