Skin necrosis induced by coumarin congeners

Abstract

Skin necrosis resulting from use of oral anticoagulants is well documented but not necessarily well known. I present here the salient features of this potentially devastating and sometimes fatal drug reaction and show images of representative lesions in 2 women under my care. Some authors refer to this condition as “coumarin-induced skin necrosis.”1-8 The term is inappropriate because coumarin itself has no anticoagulant properties, even when given in large doses over prolonged periods.9 Coumarin, however, is the parent compound of congeners that are responsible for skin necrosis: bishydroxycoumarin (dicumarol), phenprocoumon, acenocoumarol (nicoumalone), fluindione, and warfarin sodium (Coumadin®).10-14 Of these, warfarin is the one most widely used. Hence, most of the reports on anticoagulant-induced skin necrosis involve warfarin.10,11,15-29 In this editorial, we will refer to skin necrosis induced by coumarin congeners as SNICC.