Warfarin-induced limb gangrene in the setting of lung adenocarcinoma.
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| Abstract |
A 53-year-old man with lung adenocarcinoma developed pulmonary embolism and bilateral popliteal venous thrombosis. Treated with intravenous unfractionated heparin and discharged home on warfarin, he returned a week later with extending thrombosis. Treatment with heparin followed by warfarin was reinitiated. Twenty-four hours following the re-administration of warfarin, the patient's INR increased to 14.5. The platelet count dropped by more than 50%, and he developed venous limb gangrene of the left leg and skin necrosis of the right leg. Heparin-induced thrombocytopenia was ruled out, and coagulation studies showed a severe depletion of protein C as well as increased thrombin generation. The patient was transfused with fresh frozen plasma, and vitamin K was given. Heparin was continued, and after 4 weeks, the patient improved markedly showing only minimal necrosis of the toes. Venous limb gangrene is a major complication associated with warfarin therapy. Its pathogenesis is explained by a transient hypercoagulable state produced by protein C depletion that leads to microvascular thrombi progressing to venous limb gangrene. The present case emphasizes the importance of careful anticoagulation with heparin followed by slow initiation of low-dose warfarin, in order to minimize thrombotic complications.
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| Authors | Liviu Klein, Angel Galvez, Oana Klein, Juan Chediak |
| Journal | American journal of hematology (Am J Hematol) Vol. 76 Issue 2 Pg. 176-9 (Jun 2004) ISSN: 0361-8609 [Print] United States |
| PMID | 15164386 (Publication Type: Case Reports, Journal Article) |
| Copyright | Copyright 2004 Wiley-Liss, Inc. |
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