Zahra Tafseer, Jamil Sidra, Ferman Hayder, Ravikumar Yuvapriya, Voloshyna Diana, Shaik Tanveer Ahamad, Saleem Faraz, Ghaffari Muhammad Abu Zar
Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Internal Medicine, Dr. Mary Gallagher Clinic, Virginia, USA.
Cureus. 2022 Oct 16;14(10):e30354. doi: 10.7759/cureus.30354. eCollection 2022 Oct.
Warfarin is a widely known oral anticoagulant used for the treatment and prevention of thromboembolic conditions. A rare, crippling, and occasionally fatal complication of warfarin is skin necrosis, resulting in significant morbidity and mortality. Due to the disease's unknown pathophysiology and rare occurrence, the treatment guidelines are not well established. We present the case of a 14-year-old female with a history of mitral stenosis and atrial fibrillation who had been on warfarin for the last two years and now develops an acute excruciating rash within three days of reinitiation of warfarin despite enoxaparin bridging and a normal blood clotting profile. After cessation of warfarin, the skin necrosis progressed to eschar formation and resolved within four weeks. To prevent further complications, early diagnosis and treatment with intravenous vitamin K, fresh frozen plasma (FFP), and aggressive wound care are essential. The prognosis may be improved by prompt diagnosis and drug cessation.
华法林是一种广为人知的口服抗凝剂，用于治疗和预防血栓栓塞性疾病。华法林一种罕见、致残且偶尔致命的并发症是皮肤坏死，会导致显著的发病率和死亡率。由于该疾病的病理生理学不明且发病率低，治疗指南尚未完善。我们报告了一例14岁女性病例，该患者有二尖瓣狭窄和心房颤动病史，过去两年一直在服用华法林，尽管在重新开始使用华法林前进行了依诺肝素桥接且凝血指标正常，但在重新开始使用华法林三天内仍出现了急性剧痛性皮疹。停用华法林后，皮肤坏死发展为焦痂形成，并在四周内消退。为防止进一步并发症，早期诊断并静脉注射维生素K、新鲜冰冻血浆（FFP）以及积极的伤口护理至关重要。及时诊断和停药可能改善预后。
