Balestra B
Medizinische Abteilung, Ospedale della Beata Vergine, Mendrisio.
Schweiz Med Wochenschr. 1995 Feb 25;125(8):361-4.
Skin necrosis is an uncommon complication associated with coumarin or heparin therapy. The gross appearance and histology of the lesions--a paradoxical thrombosis of skin vessels--are identical. However, skin necrosis is the symptom of two different disorders. Coumarin necrosis may be related to reduced levels of protein C or S during the early stages of anticoagulation. It is possible to continue the warfarin therapy, simultaneously with heparin, if further anticoagulation is still required. In contrast, heparin necrosis is a manifestation of the potentially fatal heparin-associated thrombocytopenia and thrombosis syndrome (HATT). Immediate discontinuation of heparin is mandatory.
皮肤坏死是与香豆素或肝素治疗相关的一种罕见并发症。病变的大体外观和组织学表现——皮肤血管的反常血栓形成——是相同的。然而，皮肤坏死是两种不同疾病的症状。香豆素坏死可能与抗凝治疗早期蛋白C或S水平降低有关。如果仍需要进一步抗凝，可以在使用肝素的同时继续华法林治疗。相比之下，肝素坏死是潜在致命的肝素相关性血小板减少和血栓形成综合征（HATT）的一种表现。必须立即停用肝素。
