How is warfarin induced skin necrosis treated?

The mainstay of treatment of warfarin-induced skin necrosis is to stop warfarin. If anticoagulation is required, heparin can be used. Sometimes Vitamin K is used to hasten the reversal of warfarin effects. If there is life-threatening coagulation then protein C concentrates can be used.

How does warfarin cause necrosis?

The blood clots interrupt the blood supply to the skin, causing necrosis. Protein C is an innate anticoagulant, and as warfarin further decreases protein C levels, it can lead to massive thrombosis with necrosis and gangrene of limbs.

When does warfarin skin necrosis occur?

Skin reactions associated with warfarin commonly occur 3 to 5 days after initiating of treatment. Breasts, buttocks, abdomen, thighs, and calves are more susceptible probably because of the reduced blood supply to adipose tissue. Rapid progression of plaques to skin necrosis increases morbidity1,3.

How can you prevent warfarin induced skin necrosis?

Preventing progression of skin necrosis is possible through rapid reversal of warfarin using high doses of parenteral vitamin K and therapeutic heparin anticoagulation. Anticoagulation with heparin should continue until the necrosis shows signs of improvement.

Can skin necrosis heal on its own?

If you only have a small amount of skin necrosis, it might heal on its own or your doctor may trim away some of the dead tissue and treat the area with basic wound care in a minor procedure setting. Some doctors also treat skin necrosis with hyperbaric oxygen therapy (HBOT).

What happens if necrotic tissue is not removed?

While there is significant disagreement on the correct elocution of the word, the literature is clear that proper debridement is critical to propel wounds toward healing. Necrotic tissue, if left unchecked in a wound bed, prolongs the inflammatory phase of wound healing and can lead to wound infection.

Can you heal from necrosis?

Necrotic tissue can delay wound healing, and it is often necessary for the devitalized tissue to be removed before any progress towards healing can be made. For this reason, it is often necessary to remove necrotic tissue surgically, a process known as debridement.

Does necrotic tissue need to be removed?

Necrotic tissue comprises a physical barrier that must be removed to allow new tissue to form and cover the wound bed. Necrotic tissue is a vital medium for bacterial growth, and its removal will go a long way to decreasing wound bioburden. Necrotic tissue must be removed.

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