Mohamed Osman Reem, Suliman Alsadig, Mohamedosman Rawan, Tahameed Tasneem, Mohamed Esraa
Department of General Surgery, Al-Neelain University, Khartoum, Khartoum, Sudan.
Department of General Surgery, Sudan Medical Specialization Board, Khartoum, Khartoum, Sudan.
Ann Med Surg (Lond). 2025 Sep 12;87(11):7249-7260. doi: 10.1097/MS9.0000000000003848. eCollection 2025 Nov.
Warfarin-induced skin necrosis (WSN) is a rare but potentially life-threatening complication of anticoagulation therapy, typically emerging within the first few days of warfarin initiation. It is characterized by painful, hemorrhagic skin lesions that can rapidly progress to full-thickness tissue necrosis. This review, designed as a narrative review, provides a comprehensive and updated overview of WSN, emphasizing its clinical presentation, underlying pathophysiology, risk factors, diagnostic challenges, treatment options, and prevention strategies. A broad literature search was conducted using PubMed, Google Scholar, ScienceDirect, and Scopus, including case reports, retrospective studies, and review articles published between 1943 and 2023. Articles were selected for their relevance to the etiology, clinical features, diagnosis, management, and outcomes of WSN. The review highlights that WSN predominantly affects middle-aged women and is often associated with protein C or S deficiency, initiation of high-dose warfarin without appropriate heparin bridging, and other thrombophilic disorders. Clinical outcomes vary depending on the timing of diagnosis and intervention; early recognition is often associated with complete recovery, whereas delayed treatment may lead to extensive tissue necrosis requiring surgical intervention in up to 40% of cases, with reported mortality rates as high as 15%. Prevention through risk stratification, cautious warfarin dosing, and early recognition remains critical. By consolidating current knowledge, this review aims to support clinicians in identifying patients at risk and implementing timely interventions to improve clinical outcomes.
华法林诱导的皮肤坏死（WSN）是抗凝治疗中一种罕见但可能危及生命的并发症，通常在开始使用华法林后的头几天内出现。其特征为疼痛性出血性皮肤病变，可迅速发展为全层组织坏死。本综述作为一篇叙述性综述，全面且更新地概述了WSN，重点阐述了其临床表现、潜在病理生理学、危险因素、诊断挑战、治疗选择及预防策略。使用PubMed、谷歌学术、ScienceDirect和Scopus进行了广泛的文献检索，包括1943年至2023年间发表的病例报告、回顾性研究及综述文章。根据文章与WSN的病因、临床特征、诊断、管理及结局的相关性进行筛选。该综述强调，WSN主要影响中年女性，常与蛋白C或S缺乏、在无适当肝素桥接的情况下起始高剂量华法林以及其他血栓形成倾向疾病相关。临床结局因诊断和干预时机而异；早期识别通常与完全康复相关，而延迟治疗可能导致广泛组织坏死，高达40%的病例需要手术干预，报告的死亡率高达15%。通过风险分层、谨慎的华法林给药及早期识别进行预防仍然至关重要。通过整合当前知识，本综述旨在支持临床医生识别有风险的患者并及时实施干预措施以改善临床结局。
