PMID- 18541684
OWN - NLM
STAT- MEDLINE
DCOM- 20080724
LR  - 20190101
IS  - 1535-2900 (Electronic)
IS  - 1079-2082 (Linking)
VI  - 65
IP  - 12
DP  - 2008 Jun 15
TI  - Heparin-induced thrombocytopenia complicated by warfarin-induced skin necrosis.
PG  - 1144-7
LID - 10.2146/ajhp070352 [doi]
AB  - PURPOSE: A case of heparin-induced thrombocytopenia (HIT) complicated by 
      warfarin-induced skin necrosis (WISN) is reported. SUMMARY: A patient with a 
      history of hypertension, heart failure, and myocardial infarction was admitted to 
      the hospital after complaining of a two-day history of shortness of breath, 
      diaphoresis, and chest pain. The patient underwent a cardiac catheterization and 
      received several medications, including heparin. Suspicions of HIT occurred when 
      her platelets began to decrease severely and she developed a left groin hematoma 
      and a pseudoaneurysm. Lepirudin was initiated and a heparin platelet factor 4 
      (PF4) antibody test was performed. The results were negative and lepirudin was 
      discontinued. She was rechallenged with unfractionated heparin (UFH) after 
      surgery of the pseudoaneurysm, but her platelets began to decrease again. A 
      second PF4 test was performed, the results of which were positive. The UFH 
      treatment was discontinued. Warfarin was also initiated after surgery and the 
      patient's platelets rapidly increased after heparin was discontinued. She was 
      discharged one week later. Three days after discharge, she was readmitted after 
      complaining of severe pain and swelling of the fatty tissue of her right flank 
      that began the day after she was discharged. Some blistering and necrosis were 
      noted on the lesion. Histological sections showed focal thrombosis of vessels in 
      the deep reticular dermis consistent with WISN. Local wound care was given to 
      manage the WISN, lepirudin was initiated, and warfarin was discontinued and 
      reinstated one week later at a low dosage. CONCLUSION: A patient with HIT 
      developed severe skin necrosis after initiation of warfarin therapy.
FAU - Howard-Thompson, Amanda
AU  - Howard-Thompson A
AD  - College of Pharmacy, University of Tennessee (UT), Memphis, TN, USA.
FAU - Usery, Justin B
AU  - Usery JB
FAU - Lobo, Bob L
AU  - Lobo BL
FAU - Finch, Christopher K
AU  - Finch CK
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - England
TA  - Am J Health Syst Pharm
JT  - American journal of health-system pharmacy : AJHP : official journal of the 
      American Society of Health-System Pharmacists
JID - 9503023
RN  - 0 (Anticoagulants)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/administration & dosage/*adverse effects
MH  - Female
MH  - Heparin/administration & dosage/*adverse effects
MH  - Humans
MH  - Middle Aged
MH  - Necrosis/chemically induced
MH  - Skin/*pathology
MH  - Thrombocytopenia/*chemically induced
MH  - Warfarin/administration & dosage/*adverse effects
EDAT- 2008/06/11 09:00
MHDA- 2008/07/25 09:00
CRDT- 2008/06/11 09:00
PHST- 2008/06/11 09:00 [pubmed]
PHST- 2008/07/25 09:00 [medline]
PHST- 2008/06/11 09:00 [entrez]
AID - 65/12/1144 [pii]
AID - 10.2146/ajhp070352 [doi]
PST - ppublish
SO  - Am J Health Syst Pharm. 2008 Jun 15;65(12):1144-7. doi: 10.2146/ajhp070352.