Coumadin skin necrosis in a patient with a free protein S deficiency: case report and literature review.

Oral anticoagulants are widely used in clinical practice. Hemorrhagic complications are the most frequent adverse reactions, but a rarer complication, coumadin skin necrosis, also can be seen. The recently described association with low levels of protein C and/or free protein S is of importance in the pathophysiology of coumadin skin necrosis. This article describes the case of a patient with a functional protein S deficiency who developed coumadin skin necrosis. The condition is described, and a discussion of theories regarding its pathophysiology is presented. Current treatment recommendations are listed.