Coumarin necrosis
The coumarin ( Syn. : Warfarinnekrose , Marcumarnekrose ) is a rare side effect of an anticoagulant therapy with a coumarin -Präparat. The incidence is less than 0.1% of those treated with this group of substances.
| Classification according to ICD-10 | |
|---|---|
| R02 | Gangrene, not elsewhere classified |
| ICD-10 online (WHO version 2019) | |
A few days after the start of therapy, this often results in pressure-sensitive patchy skin changes that usually appear reddened at first. Over the course of a few days, bloody blisters or an increasingly black color will form there. The end stage is usually death (" necrosis ") of the affected skin area with scarring. The trunk is usually affected.
The exact cause of coumarin necrosis is still unclear; it is assumed that the capillary wall was initially damaged with subsequent thrombotic occlusion of small capillary vessels. Coumarin necrosis is likely to occur more frequently in women, in obese people, with initially high doses of the coumarin preparation and in patients with a deficiency of protein C.
Specific therapy is not possible; this is limited to local wound treatment, in the case of extensive defects, possibly with skin grafts and possibly also with amputations .
A low dose of the coumarin preparation at the start of therapy and an overlapping treatment with heparin in the first few days are considered suitable means of reducing the risk of coumarin necrosis. However, in rare cases, unfractionated heparin can also cause skin necrosis when coumarin is administered at the same time.
swell
- I. Jorg et al: Anticoagulant-related skin reactions. In: Expert Opin Drug Saf . (2002); 1 (3), pp. 287-294. PMID 12904144 .
Individual evidence
- ↑ S. Sanchez-Politta et al.: Widespread skin necrosis associated with unfractionated heparin therapy in a patient under chronic coumarin anticoagulation. In: J Eur Acad Dermatol Venereol. (2006); 20 (3), pp. 327-330. PMID 16503898 .
