Cutaneous necrosis associated with warfarin use has been described, with a prevalence between 0.01 and 0.1% of patients treated.
Although the mechanism is not clear, a transient fall in protein C1,2 is described.
The clinical picture manifests as sudden edema and erythema associated with pain or paresthesia.
In 90% of cases, the onset of skin necrosis occurs 3 to 6 days after starting treatment, although cases have been reported that have developed weeks or months later3.
Histopathological examination revealed thrombosis and fibrin deposits in post-capillary venules without infamation4,5.
The treatment is suspension of the drug, fresh frozen plasma transfusion and intravenous vitamin K intake.
