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Successful treatment of warfarin-induced skin necrosis using oral rivaroxaban: A case report

World Journal of Clinical Cases 2019年第24期7卷 4285-4291页

作者： Momoka Kamada Tsuneaki Kenzaka Department of Internal Medicine Hyogo Prefectural Tamba Medical CenterTamba 669-3395Japan Division of Community Medicine and Career Development Kobe University Graduate School of MedicineKobe 652-0032Japan

BACKGROUND Heparin is commonly recommended for warfarin-induced skin necrosis;however, there is currently no established therapy for this disease. We present a serious case of warfarin-induced skin necrosis that was successfully treated with oral rivaroxaban, a factor Xa *** SUMMARY A 48-year-old woman was admitted to the hospital for cellulitis of the right lower extremity. After antibiotic treatment, she developed pain and swelling of the left lower extremity, and deep vein thrombosis of both lower extremities was diagnosed. She was treated with a continuous heparin injection;subsequently,oral warfarin was concomitantly administered. Heparin was terminated after the therapeutic range was reached. On the following day, the patient had swelling and pain in the left lower extremity. In addition to decrease in protein S activity due to systemic lupus erythematosus, warfarin also reduced protein C activity,resulting in further hypercoagulation and skin necrosis. Warfarin was discontinued, and continuous heparin injection was resumed. Although the patient had to undergo amputation of the distal end of her left foot, continuous heparin injection was switched to oral rivaroxaban, and she was eventually discharged from the hospital in *** Administration of direct oral anticoagulants instead of warfarin is important in patients with decreased protein S and C activity.

关键词： skin necrosis Warfarin Heparin Rivaroxaban Systemic lupus erythematosus Case report

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Delayed Onset Low Molecular Weight Heparin Induced skin necrosis on a Hemodialysis Patient

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Open Journal of Nephrology 2023年第2期13卷 74-80页

作者： Suzanne J. Sanchez Ruben A. Maguad Grecia P. Darunday Adult Nephrology Department Perpetual Succour Hospital Cebu City Philippine

Delayed onset low molecular weight heparin induced skin necrosis is a rare adverse event. It usually occurs at the site of injection, and typically develops within 2 weeks of starting therapy. However, in our case, we presented a 62-year-old woman who is on Hemodialysis twice a week. Her hemodialysis prescription included Enoxaparine 0.2 cc IV as anticoagulant. On her third month of regular hemodialysis, she developed skin necrosis on her right leg and left hand. The diagnosis was made clinically and by exclusion of other possible causes of skin necrosis in a chronic kidney disease patient, such as calciphylaxis. The most important aspect of management, in this case, is early recognition and withdrawal of its use, which were done in our patient.

关键词： Heparin skin necrosis Hemodialysis

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Effect of electroacupuncture at Zuansanli(ST36) on dorsal randompattern skin flap survival in a rat model

Effect of electroacupuncture at Zuansanli(ST36) on dorsal ra...

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2014年浙江省医学会手外科暨显微外科学学术年会

作者：手外科蔡乐益林丁盛温州医科大学附属第二医院

Introduction Acupuncture especially is one of the most frequently requested of the complementary therapies in western countries *** at Zusanli(ST36)could accelerate angiogenesis by up-regulating HIF-1 protein,and enhance skin microcirculation blood *** addition,it was used to antioxidant,which can inhibit the formation of *** paper aims to study how electroacupuncture at Zuansanli(ST36)effects on randompattern flap survival rate through animal *** and methods:Thirty female Sprague-Dawley rats were randomly divided into three groups:Control(no postoperative electroacupuncture)and Study A(postoperative electroacupuncture at non-acupoint areas,10 Hz for 30 min per day)and Study B(postoperative electroacupuncture at Zusanli,10 Hz for 30 min per day).The"McFarlane flap"rat models were established on the rat *** 7days’electroacupuncture,the flap survival area ratio was *** tissue samples were taken for histological *** VEGF,MDA and SOD expression were detected by ***:7 days after operation,the flap necrotic areas ratio in control group(66.65±2.81)%and in study A(64.65±2.42)%were significantly enlarged compared with that of the study B(48.81±2.33)%(P<0.01).Histological analysis demonstrated angiogenesis with mean vessel density per mm2 being lower in control group(15.4±4.4)and in study A(17.4±4.3)than in control group(27.2±4.1)(P<0.05).VEGF expression and SOD contents were significantly increased in study B Group compared with study A Group and control group(p<0.01),whereas MDA level was reduced(p<0.05).Conclusions:Electroacupuncture at Zuansanli(ST36)may increase the expression of VEGF,which can effectively increase angiogenesis to provide inadequate vascular *** block the release of ischemia-reperfusion injuryassociated free radical,as well as the production of the superoxide *** addition,the up-regulated SOD and the down-regulated MDA are evidence

关键词： flap survival skin necrosis Zuansanli(ST36) random-pattern skin flap electroacupuncture

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Effect of huangqi injection on dorsal random-pattern skin flap survival in a rat model

Effect of huangqi injection on dorsal random-pattern skin fl...

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2014年浙江省医学会手外科暨显微外科学学术年会

作者：蔡乐益林丁盛温州医科大学附属第二医院手外科

Intruction:As a common Chinese herbal medicine,Huangqi injection is widely used in *** has function on comparable angiogenic effects,for the munber of capillaries,the hemoglobin content and the expression of CD34were remarkably *** addition,it was used to antioxidant,which can inhibit the formation of *** paper aims to study how Huangqi injection effects on 9cm*3cm dorsal random-pattern flap survival rate through animal *** and methods:McFarlane flap model was established on the rat dorsum,Sprague Dawley rats were randomly divided into the Huangqi injuection experimental group[6mL/(kg*d)]and the control group[6mL/(kg*d)].After 7days’injection,the flap survival area ratio was *** tissue samples were taken for histological *** VEGF,MDA and SOD expression were detected by ***:7 days after operation,the flap survival areas ratio in study group(60.66±2.81)%was significantly enlarged compared with that of the control group(45.81±2.34)%(P<0.01).Histological analysis demonstrated angiogenesis with mean vessel density per mm2 being higher in study group(35.4±4.4)than in control group(27.2±4.1)(P<0.05).The expression of VEGF in study group was(3765±531.64),and in control group was(2638±760.32)(P<0.01).What’more,There are significant differences in the huangqi injection group level of malondialdehyde(MDA)that is 16.1571 nmol/g,and the control group was 32.2107 nmol/g,the difference was also statistically significant(P<0.05).And the superoxide dismutase(SOD)in the huangqi injection is in the experimental group was significantly higher than that of the control group[(160.2±23.4 U/g)vs(19.01±2.2 U/g),P<0.05].Conclusions:Huangqi injection may increase the expression of VEGF,which can effectively increase angiogenesis to provide inadequate vascular *** block the release of ischemia-reperfusion injury-associated free radical,as well as the production of the superoxide *** additio

关键词： flap survival skin necrosis huangqi injection random-pattern skin flap

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Effect of Xuebijing injection on dorsal random-pattern skin flap survival in a rat model

Effect of Xuebijing injection on dorsal random-pattern skin ...

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2014年浙江省医学会手外科暨显微外科学学术年会

作者：蔡乐益林丁盛温州医科大学附属第二医院手外科

Intruction:Random flaps can be used throughout the hand and *** injection is widely used in chlinical with function on comparable angiogenic effects,reduction the systemic inflammatory *** research is to investigate the effect of Xuebijing injection on random skin flap *** and methods:Thirty female Sprague-Dawley rats were randomly divided into two groups:Control(subdermal application of saline solution at 0.9%,2ml/kg)and Study(subdermal application of Xuebijing injection,2ml/kg).The"McFarlane flap"rat models were established on the rat *** 7days’injection,the flap survival area ratio was *** tissue samples were taken for histological *** VEGF,MDA and SOD expression were detected by ***:7 days after operation,the flap survival areas ratio in study group(57.66±3.81)%was significantly enlarged compared with that of the control group(47.81±2.34)%(P<0.05).Histological analysis demonstrated angiogenesis with mean vessel density per mm2 being higher in study group(33.4±4.1)than in control group(26.2±4.2)(P<0.05).The expression of VEGF in study group was(3845±532.54),and in control group was(2546±732.31)(P<0.05).Moreover,there are significant differences in study injection group level of malondialdehyde(MDA)that is 15.1531 nmol/g,and the control group was 34.2601 nmol/g,the difference was also statistically significant(P<0.05).And the superoxide dismutase(SOD)in the huangqi injection is in the experimental group was significantly higher than that of the control group[(156.2±22.3 U/g)vs(17.01±1.7 U/g),P<0.05].Conclusions:Xuebijing injuection may increase the expression of VEGF,which can effectively increase angiogenesis to provide inadequate vascular *** block the release of ischemia-reperfusion injury-associated free radical,as well as the production of the superoxide *** addition,the up-regulated SOD and the down-regulated MDA are evidence for *** all,Xuebijing ca

关键词： flap survival skin necrosis Xuebijing injection random-pattern skin flap VEGF

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