A Case Report on Warfarin Induced Skin Necrosis: Drug-drug Interaction or Inappropriate Therapy

Introduction: Warfarin is one of the most frequently prescribed oral anticoagulant. Necrosis and/or gangrene ofskin and other tissues is an uncommon but serious risk associated with warfarin. The incidence of warfarin inducedtissue necrosis is about 0.01 % to 0.1%.Case description: A 62-year-old male presented to emergency with a complaint of skin discoloration and edema onleft lower limb diagnosed as warfarin induced skin necrosis. He had an episode of hemiparesis 20 days back for whichhe was started on oral warfarin along with other medications. On diagnosis warfarin was stopped and fresh frozenplasma (FFP) was given along with vitamin K. Due to progressing tissue necrosis, above knee limb amputation wasdone. We assume that an interaction between rosuvastatin and warfarin or possibly lack of adequate bridge therapywith heparin resulted in this complication.Conclusion: Warfarin induced skin necrosis is a known early complication of the therapy. Though late onsetappearance of this event is rare but not unknown. Bridging therapy with heparin and avoiding use of interactingdrugs concomitantly could prevent many such reactions.