Coumadin-Induced Skin Necrosis

Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN


Wounds. 2002;14(6) 

In This Article

Historical Background

Coumadin (Bristol-Myers Squibb, New York, NY) was first introduced in 1941. Warfarin-induced skin necrosis was described by Flood and colleagues[1] who reported a case of a gangrenous breast but erroneously believed it was due to an underlying coagulopathy and not the drug therapy.[2,3] In 1954, Verhagen described a series of 13 patients on dicumarol who developed necrosis, but he incorrectly suggested the necrosis was associated with the underlying disease being treated when in fact it was complicated by a thrombosis and dicumarol therapy.[4] Kipen first correctly ascribed the gangrenous skin changes to anticoagulant therapy.[5]

CISN is known by several names: WISN, coumarin-congener-associated skin necrosis, and warfarin dermal gangrene. Important to note is that coumarin is the parent compound for several anticoagulants (i.e., sodium warfarin [Coumadin], bishydroxycoumarin [dicoumarol]). Coumarin itself is not an anticoagulant; therefore, calling the condition by that name is somewhat of a misnomer.[6]


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