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June 1993

Treatment of Coumarin-Induced Skin Necrosis With a Monoclonal Antibody Purified Protein C Concentrate

Author Affiliations

From the Medizinische Klinik Innenstadt, University of Munich (Germany) (Drs Schramm and Spannagl); Hematology-Oncology Division, Beth Israel Hospital and Harvard Medical School, Boston, Mass (Drs Bauer and Rosenberg); Staedtisches Krankenhaus Bogenhausen, Munich, Germany (Dr Birkner); and Immuno AG, Vienna, Austria (Drs Linnau and Schwarz).

Arch Dermatol. 1993;129(6):753-756. doi:10.1001/archderm.1993.01680270091012

• Background and Design.—  Protein C is a vitamin K—dependent plasma protein that is converted to the serine protease activated protein C by the thrombin-thrombomodulin complex. Activated protein C functions as a natural anticoagulant by inactivating the cofactors of the coagulation cascade, factors Va and Villa. Coumarin (warfarin)-induced skin necrosis is thought to be due to a rapid elimination of protein C relative to other vitamin K—dependent factors during the initial phase of oral anticoagulation. We have used a highly purified protein C concentrate to treat a patient with acquired protein C deficiency who developed skin necrosis during the initial phase of oral anticoagulant therapy.

Observations and Conclusions.—  During protein C concentrate therapy, no further skin lesions appeared, and the healing process of necrotic areas was facilitated. Replacement therapy with protein C concentrate appears to be safe and effective as an adjunctive treatment for coumarin-induced skin necrosis.(Arch Dermatol. 1993;129:753-756)

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