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Skin necrosis following prolonged administration of coumarin in a patient with inherited protein S deficiency
Author(s) -
Goldberg Stuart L.,
Kessler Craig M.,
Yalisove Barbara L.,
Elgart Mervyn L.,
Orthner Carolyn L.
Publication year - 1991
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.2830380111
Subject(s) - necrosis , medicine , coumarin , protein c deficiency , protein s deficiency , anticoagulant , protein s , sulfonamide , protein c , immunology , thrombosis , biology , chemistry , venous thrombosis , stereochemistry , botany
Abstract Depression of the vitamin K‐dependent modulators of coagulation during the initial phase of oral anticoagulant therapy may lead to a transient hypercoagulable state and skin necrosis. We report a case of skin necrosis associated with inherited protein S deficiency following prolonged coumarin therapy. As a result of a stasis ulceration causing a rise in c4b binding protein and concurrent treatment with topical sulfonamide, we hypothesize that a precipitous decrease in free protein S led to skin necrosis. Progression of the necrosis was halted with unactivated prothrombin complex concentrate. This case confirms the rare association between coumarin induced skin necrosis and protein S deficiency and emphasizes potential drug interactions.