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Warfarin-induced skin necrosis following heparin-induced thrombocytopenia.
Proceedings of the Baylor University Medical Center 2016 January
Anticoagulants, such as heparin and warfarin, are commonly used in the treatment and prevention of thromboembolic events. The risk of developing warfarin-induced skin necrosis (WISN) with warfarin is reported to be <1%. However, the risk of WISN may be increased with the initiation of warfarin in the setting of heparin-induced thrombocytopenia and thrombosis syndrome (HITT). WISN can lead to catastrophic tissue necrosis requiring amputations and mass debridement. This report describes a case of WISN following HITT and discusses the appropriate medical management of patients with HITT to avoid secondary WISN.
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