Kamada M, Kenzaka T. Successful treatment of warfarin-induced skin necrosis using oral rivaroxaban: A case report. World J Clin Cases 2019; 7(24): 4285-4291 [PMID: 31911909 DOI: 10.12998/wjcc.v7.i24.4285]
Corresponding Author of This Article
Tsuneaki Kenzaka, MD, PhD, Professor, Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe 652-0032, Japan. smile.kenzaka@jichi.ac.jp
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 26, 2019; 7(24): 4285-4291 Published online Dec 26, 2019. doi: 10.12998/wjcc.v7.i24.4285
Successful treatment of warfarin-induced skin necrosis using oral rivaroxaban: A case report
Momoka Kamada, Tsuneaki Kenzaka
Momoka Kamada, Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba 669-3395, Japan
Tsuneaki Kenzaka, Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe 652-0032, Japan
Author contributions: Kamada M managed the case and redaction and correction of the manuscript; Kenzaka T assisted with redaction, correction, and reconstruction of the manuscript; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor of this journal.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist statement, and the manuscript was prepared and revised according to the CARE Checklist statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tsuneaki Kenzaka, MD, PhD, Professor, Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe 652-0032, Japan. smile.kenzaka@jichi.ac.jp
Telephone: +81-78-3826732 Fax: +81-78-3826283
Received: September 2, 2019 Peer-review started: September 2, 2019 First decision: November 13, 2019 Revised: November 17, 2019 Accepted: November 30, 2019 Article in press: November 30, 2019 Published online: December 26, 2019 Processing time: 113 Days and 20.2 Hours
Abstract
BACKGROUND
Heparin is commonly recommended for warfarin-induced skin necrosis; however, there is currently no established therapy for this disease. We present a serious case of warfarin-induced skin necrosis that was successfully treated with oral rivaroxaban, a factor Xa inhibitor.
CASE SUMMARY
A 48-year-old woman was admitted to the hospital for cellulitis of the right lower extremity. After antibiotic treatment, she developed pain and swelling of the left lower extremity, and deep vein thrombosis of both lower extremities was diagnosed. She was treated with a continuous heparin injection; subsequently, oral warfarin was concomitantly administered. Heparin was terminated after the therapeutic range was reached. On the following day, the patient had swelling and pain in the left lower extremity. In addition to decrease in protein S activity due to systemic lupus erythematosus, warfarin also reduced protein C activity, resulting in further hypercoagulation and skin necrosis. Warfarin was discontinued, and continuous heparin injection was resumed. Although the patient had to undergo amputation of the distal end of her left foot, continuous heparin injection was switched to oral rivaroxaban, and she was eventually discharged from the hospital in remission.
CONCLUSION
Administration of direct oral anticoagulants instead of warfarin is important in patients with decreased protein S and C activity.
Core tip: We present a serious case of warfarin-induced skin necrosis that was successfully treated with oral rivaroxaban, a factor Xa inhibitor. Administration of direct oral anticoagulants instead of warfarin is important in patients with decreased protein S and C activity.
