Jillella A P, Lutcher C L
Section of Hematology and Oncology, Department of Internal Medicine, Medical College of Georgia, Augusta, USA.
Am J Hematol. 1996 Jun;52(2):117-9. doi: 10.1002/(SICI)1096-8652(199606)52:2<117::AID-AJH9>3.0.CO;2-X.
Skin necrosis is a rare but serious complication of oral anticoagulation with coumarin derivatives. Frequently, the necrosis can be extensive and may result in major morbidity and mortality. The majority of these patients require prolonged anticoagulation for life-threatening conditions such as deep various thrombosis and pulmonary embolism. Resuming oral anticoagulants in the face of skin necrosis is a difficult decision for both the patient and the physician. Because long-term heparin therapy is inconvenient and is associated with significant side effects, we reviewed the literature to find alternative treatment strategies. A Medline search was done, and all papers published in English since 1967 were reviewed. Of 58 cases with skin necrosis attributed to oral anticoagulants, oral anticoagulation was resumed in 7 patients with no resulting adverse effects. Warfarin is the most widely used coumarin derivative in the United States. Based on our review, we make recommendations for resuming warfarin in patients who have developed skin necrosis when the clinical condition absolutely requires prolonged anticoagulation.
皮肤坏死是使用香豆素衍生物进行口服抗凝治疗时罕见但严重的并发症。通常，坏死范围可能很广，并可能导致严重的发病和死亡。这些患者中的大多数因深部静脉血栓形成和肺栓塞等危及生命的疾病需要长期抗凝治疗。对于患者和医生而言，在出现皮肤坏死的情况下恢复口服抗凝剂都是一个艰难的决定。由于长期肝素治疗不方便且伴有明显的副作用，我们查阅了文献以寻找替代治疗策略。我们进行了Medline检索，并对自1967年以来发表的所有英文论文进行了综述。在58例归因于口服抗凝剂的皮肤坏死病例中，7例患者恢复口服抗凝治疗后未产生不良反应。华法林是美国使用最广泛的香豆素衍生物。基于我们的综述，我们对临床状况绝对需要长期抗凝治疗且已发生皮肤坏死的患者恢复使用华法林提出了建议。
