Anticoagulant-related skin necrosis
Warfarin necrosis on days 3 to 5 in fatty areas, heparin injection-site necrosis as a sign of HIT, venous limb gangrene when warfarin is given in acute HIT, and what to stop, start and reverse in each.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Three syndromes, all caused by microvascular thrombosis, not bleeding:
- Warfarin-induced skin necrosis: days 3 to 5, fatty areas, transient protein C depletion
- Heparin-induced skin necrosis at injection sites: a marker of HIT, even with a normal platelet count
- Venous limb gangrene: acute HIT treated with warfarin before platelet recovery
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Sources
- Mohamed Osman R et al. Warfarin-induced skin necrosis: a narrative review of clinical features, risk factors, and treatment strategies. Ann Med Surg (Lond) 2025;87(11):7249-60Annals of Medicine and Surgery, 2025
- Chan YC, Valenti D, Mansfield AO, Stansby G. Warfarin induced skin necrosis. Br J Surg 2000;87:266-72British Journal of Surgery, 2000
- Cuker A et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv 2018;2(22):3360-92American Society of Hematology, 2018 (no newer ASH HIT guideline found, checked 12 November 2026)
- Therapeutic Guidelines: Cardiovascular (anticoagulant therapy)AU/NZTherapeutic Guidelines Limited (eTG complete), current eTG edition (topic version not verified)
- Tran HA, Chunilal SD, Harper PL et al. An update of consensus guidelines for warfarin reversal. Med J Aust 2013;198(4):198-9AU/NZAustralasian Society of Thrombosis and Haemostasis (Med J Aust), 2013
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback