Coumadin-Induced Skin Necrosis

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


Wounds. 2002;14(6) 

In This Article


Advice from clinicians for CISN prevention is available in the literature, although no clinical trials have been done to validate their perspectives. First, recognition of the population at risk is crucial. Acutely ill women started on Coumadin for prophylaxis or treatment of thromboembolic disease and those with plasmaprotein C and S and Antithrombin III deficiencies are at highest risk. Second, large loading doses of warfarin (>15mg) are not recommended; a daily dose of 7.5mg to 10mg is often prescribed, with adjustments as necessary. Full heparinization should be achieved before starting warfarin. Clinicians also should be aware of the syndrome and especially attuned to patients' early complaints of localized skin discomfort -- especially in the breast, buttocks, and thighs -- even in the absence of overt signs. A high level of suspicion may allow rapid reversal of warfarin with therapeutic heparinization before the syndrome processes begin.[7,11]


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