Think about Virchow's Triad:1. Stasis: anything that prevents blood flow will be contribute to coagulation eg. venous compression (lymph node, mass), long plane ride, etc.
2. Endothelial Damage: is there damage to the delicate endothelial wall? eg. trauma or instrumentation.
3. Hypercoaguable States: Remeber that there are hereditary and acquired causes.
Hereditary causes include the Factor V Leiden mutation, Prothrombin 20210 mutation, Protein C deficiency, Protein S deficiency, and Antithrombin III deficiency.
Acquired causes include malignancy, surgery/trauma, pregnancy, drugs (eg OCP, HRT), nephrotic syndrome, inflammatory bowel disease, antiphospholipid antibody syndrome, hyperhomocysteinemia, myeloproliferative disorders (like polycythemia rubra vera, essential thrombocytosis), paroxysmal nocturnal hemoglobinurea, and immobility.
Warfarin-Induced Skin Necrosis
This is a rare complication of warfarin that may present within a week after the drug is initiated. Necrotic skin lesions are more commonly seen on the trunk and extremities. Warfarin initially decreases levels of Protein C, causing a hypercoaguable state - the necrosis is from microthrombi in the skin (see picture below). This condition is associated with high doses of warfarin (>10 mg) and Protein C deficiency. Stop the warfarin, and use another anticoagulant.
This is a rare complication of warfarin that may present within a week after the drug is initiated. Necrotic skin lesions are more commonly seen on the trunk and extremities. Warfarin initially decreases levels of Protein C, causing a hypercoaguable state - the necrosis is from microthrombi in the skin (see picture below). This condition is associated with high doses of warfarin (>10 mg) and Protein C deficiency. Stop the warfarin, and use another anticoagulant.
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