Humphries J E, Gardner J H, Connelly J E
Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville.
Am J Hematol. 1991 Jul;37(3):197-200. doi: 10.1002/ajh.2830370313.
Skin necrosis is a well-known yet rare complication of oral anticoagulant therapy. We report the unusual recurrence of lesions typical of warfarin skin necrosis in the absence of anticoagulant therapy. A 59-year-old woman developed skin necrosis while receiving prophylactic warfarin following the detection of a large left ventricular thrombus. The warfarin was discontinued and the lesions improved. One month later new areas of skin necrosis developed although the patient had received no further warfarin. Progressive congestive heart failure, poor nutrition, and prolonged oral antibiotic therapy preceded the recurrence. Vitamin K deficiency was present on admission. The potential role of vitamin K-dependent coagulation factors in the pathogenesis of anticoagulant-associated skin necrosis is discussed.
皮肤坏死是口服抗凝治疗一种众所周知但罕见的并发症。我们报告了在未进行抗凝治疗的情况下，华法林皮肤坏死典型病变异常复发的病例。一名59岁女性在检测到左心室大血栓后接受预防性华法林治疗时发生了皮肤坏死。停用华法林后病变有所改善。尽管患者未再接受华法林治疗，但一个月后出现了新的皮肤坏死区域。复发前有进行性充血性心力衰竭、营养不良和长期口服抗生素治疗。入院时存在维生素K缺乏。讨论了维生素K依赖凝血因子在抗凝相关皮肤坏死发病机制中的潜在作用。
