Warfarin Induced Skin Necrosis: Presentation of Two Cases

AbstractSkin necrosis is an uncommon complication of warfarin therapy. Painful skin lesions are initially erythematous and hemorrhagic; they become bullous and eventually proceed to gangrenous necrosis. We present two cases with skin necrosis due to warfarin use. The first patient was a 72-year-old man who was admitted with abdominal pain and dyspnoea. He was on warfarin for atrial fibrillation, as well as other cardiac and respiratory drugs for congestive heart failure and atrial fibrillation. He had purpural rashes on his lower limbs. Warfarin treatment was ceased because of skin necrosis formation and he died from cardiogenic shock in the intensive care unit. The second patient was a 66-year-old female with recurrent bilateral lower extremity swelling. She had been using warfarin 10 mg/day for 15 days for the treatment of deep vein thrombosis. She had necrotic and bullous lesions on her left lower limb. Treatment of the lesion was wet to dry dressings soaked with zinc for 10 days and warfarin treatment was replaced with low molecular weight heparine 2 mg/kg/day. Because of the deep vein thrombosis, a vena cava filter was placed by invasive radiologists for pulmonary embolism prophylaxis. She was discharged without any complications