DeFranzo A J, Marasco P, Argenta L C
Department of Plastic and Reconstructive Surgery, Wake Forest University Medical Center, Winston-Salem, NC, USA.
Ann Plast Surg. 1995 Feb;34(2):203-8. doi: 10.1097/00000637-199502000-00017.
Warfarin (Coumadin)-induced necrosis of the skin is an unusual condition associated with the administration of warfarin. The necrotic lesions appear suddenly and are extremely painful. Single or multiple lesions develop in a distinct pattern. A hypercoagulable state created early in the course of warfarin administration is most likely responsible for warfarin-associated necrosis. Functional and inherited low levels of proteins C and S are found in some patients. The differential diagnosis of warfarin necrosis is of interest to the plastic surgeon. The condition may mimic purpura fulminans, necrotizing fasciitis, microembolization, breast cancer, and decubitus ulcers. Early recognition and treatment are essential to avoid significant and prolonged morbidity. Mortality has also been reported. We present 2 cases of warfarin-induced necrosis and a review of the literature.
华法林（香豆素）诱发的皮肤坏死是一种与华法林使用相关的罕见病症。坏死性损害突然出现且极为疼痛。单个或多个损害以独特的模式发展。华法林治疗早期形成的高凝状态很可能是华法林相关坏死的病因。在一些患者中发现功能性和遗传性蛋白C及蛋白S水平低下。整形外科医生对华法林坏死的鉴别诊断很感兴趣。该病症可能类似暴发性紫癜、坏死性筋膜炎、微栓塞、乳腺癌及褥疮溃疡。早期识别和治疗对于避免严重且长期的发病至关重要。也有关于死亡病例的报道。我们呈现2例华法林诱发的坏死病例并对文献进行综述。
