How is WISN prevented in protein C deficiency?

Updated: Jan 04, 2019
  • Author: Shamudheen Rafiyath, MD; Chief Editor: Perumal Thiagarajan, MD  more...
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For patients with heterozygous protein C deficiency, the following is recommended in order to avoid the development of warfarin-induced skin necrosis:

  • Large loading doses of warfarin (>5 mg/d) should be avoided.

  • When warfarin is initiated, it should be overlapped with a parenteral anticoagulant such as unfractionated or low molecular weight heparin.

  • The parenteral anticoagulant should be continued for at least 5 days and until the international normalized ratio (INR) measurement has been 2.0 or greater for at least 2 days.

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