Khalid K
The Department of General Surgery, Al-Iman General Hospital, Riyadh, Saudi Arabia.
J Postgrad Med. 2004 Oct-Dec;50(4):268-9.
Warfarin-induced necrosis of the breast is an unusual complication of warfarin therapy. Since its first description in 1943, up to 36 cases have been reported in the English literature. Close association between inherited or functional deficiency of protein C and S and warfarin therapy is frequently reported. A characteristic patient is an obese middle-aged female receiving anticoagulant treatment. The rapidly evolving painful lesion appears suddenly, usually within 3 to 6 days after initiation of warfarin therapy. Prevention may be achieved by identifying the high-risk patients-female gender, middle age, obesity, and avoiding large loading doses of warfarin. Early recognition and treatment are necessary to avoid significant long-term morbidity. Established necrosis necessitates debridement and sometimes mastectomy. A case of warfarin-induced necrosis of the left breast mimicking inflammatory cancer is reported. Current recommendations for the prevention and treatment of this uncommon condition are reviewed.
华法林所致乳腺坏死是华法林治疗一种罕见的并发症。自1943年首次被描述以来，英文文献中已报道了多达36例。蛋白C和S的遗传性或功能性缺乏与华法林治疗之间的密切关联屡有报道。典型患者是接受抗凝治疗的肥胖中年女性。迅速进展的疼痛性病变通常在华法林治疗开始后3至6天内突然出现。通过识别高危患者（女性、中年、肥胖）并避免大剂量负荷使用华法林可实现预防。早期识别和治疗对于避免严重的长期发病率很有必要。已确诊的坏死需要清创，有时还需要乳房切除术。本文报道了1例酷似炎性癌的左乳华法林所致坏死病例。并对这种罕见病症的预防和治疗的当前建议进行了综述。
