Coumarin Necrosis Associated with Hereditary Protein C Deficiency
Authors: WILLIAM G. McGEHEE
Journal: Annals of Internal Medicine (1984)

Brief Reports1 July 1984Coumarin Necrosis Associated with Hereditary Protein C DeficiencyWILLIAM G. McGEHEE, M.D., THOMAS A. KLOTZ, M.D., DAVID J. EPSTEIN, M.D., SAMUEL I. RAPAPORT, M.D.WILLIAM G. McGEHEE, M.D., THOMAS A. KLOTZ, M.D., DAVID J. EPSTEIN, M.D., SAMUEL I. RAPAPORT, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-101-1-59 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptCoumarin skin necrosis is an uncommon but well recognized complication of oral anticoagulant therapy (1). We have discovered that a patient with coumarin penile necrosis whose case was previously reported (2) has hereditary deficiency of protein C. Our observation provides insight into the mechanism of this paradoxical thrombotic complication of anticoagulant therapy.A 33-year-old man was hospitalized for recurrent deep vein thrombosis of the legs. Heparin and warfarin therapy had been given previously without complications. He was initially treated with intravenous heparin; warfarin was begun on the eighth day. Forty-eight hours after the first of two 20-mg doses, he awoke...References1. HORNDANZIGERDAVIS JLR. Warfarin-induced skin necrosis: report of four cases. Am J Hosp Pharm. 1981;38:1763-8. MedlineGoogle Scholar2. WEINBERGLIESKOVSKYMCGEHEESKINNER AGWD. Warfarin necrosis of the skin and subcutaneous tissue of the male external genitalia. J Urol. 1983;130:352-4. CrossrefMedlineGoogle Scholar3. EPSTEINBERGUMBAJAJRAPAPORT DPSS. Radioimmunoassay of protein C. Am J Clin Pathol. (In press). Google Scholar4. GRIFFINEVATTZIMMERMANKLEISSWIDEMAN JBTAC. Deficiency of protein C in congenital thrombotic disease. J Clin Invest. 1981;68:1370-3. CrossrefMedlineGoogle Scholar5. BROEKMANSVELTKAMPBERTINA AJR. Congenital protein C deficiency and venous thromboembolism: a study of three Dutch families. N Engl J Med. 1983;309:340-4. CrossrefMedlineGoogle Scholar6. SELIGSOHNBERGERABENDRUBINATTIASZIVELINRAPAPORT UAMLDAS. Homozygous protein C deficiency manifested by massive venous thrombosis in the newborn. N Engl J Med. 1984;310:559-62. CrossrefMedlineGoogle Scholar7. EPSTEINBERGUMRAPAPORT DPS. Kinetics of protein C depression after Coumadin administration [Abstract]. Circulation. 1983;68(supp III):1264. MedlineGoogle Scholar8. VIGANOMANNUCISOLINASBOTTASSOD'ANGELOMARIANI SPSBAG. Early fall of protein C during short term anticoagulant treatment [Abstract]. Thromb Haemost. 1983;50:310. Google Scholar9. BROEKMANSBERTINALOELIGERHOFMANNKLINGEMANN AREVH. Protein C and the development of skin necrosis during anticoagulant therapy [Letter]. Thromb Haemost. 1983;49:251. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: University of Southern California School of Medicine Los Angeles, California University of California at San Diego School of Medicine San Diego, California PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySymmetrical peripheral gangrene in critical illnessProtein CHypercoagulable StatesCASE OF ATYPICAL WARFARIN-INDUCED SKIN NECROSIS IN A CHILD WITH CONGENITAL HEART DISEASEPurpura FulminansProtein C DeficiencyThrombophiliaOverview of Anticoagulation AgentsAdverse Drug Reactions and Cutaneous Manifestations Associated With AnticoagulationCutaneous Drug Reactions in the ElderlyCerebral Venous Thrombosis: Genetic AspectsActivated Protein CLate failure of a split-thickness skin graft in the setting of homozygous factor V Leiden mutation: a case report and correlative animal model from the Wound Etiology and Healing (WE-HEAL) studyWarfarin‐induced skin necrosis following recommencement of 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Part I: General Aspects and Fat-Solumbe VitaminsChapter 9B Inhibitors: protein CThromboembolism, Coumarin Necrosis, and Protein CA radioimmunoassay for protein CThe antiprogesterones are comingCerebral haemorrhagic infarction in young patients with hereditary protein C deficiencyCerebral haemorrhagic infarction in young patients with hereditary protein C deficiencyCerebral haemorrhagic infarction in young patients with hereditary protein C deficiency: evidence for "spontaneous" cerebral venous thrombosis.Andere angeborene KoagulopathienDrugs affecting blood clotting and hemostasisWarfarinDrugs, Wound Healing and Cutaneous Ulcers 1 July 1984Volume 101, Issue 1Page: 59-60KeywordsAnticoagulant therapyCoumarinsDeep vein thrombosisHeparinMedical servicesNecrosisProtein C deficiency Issue Published: 1 July 1984 PDF downloadLoading ...