Necrosis cutánea por tratamiento anticoagulante oral: caso clínico / Cutaneous necrosis caused by acenocumarol: case report

Cutaneous necrosis is a rare but serious complication, among patients treated with warfarin or acenocumarol derivatives. We report a 71 years old female with a history of deep venous thrombosis, receiving acenocumarol for three months. The treatment was discontinued, but had to be restarted, due to a new episode of thrombosis. Three days after restarting acenocumarol, the patient consulted for ecchymosis and pain of the right foot. At physical examination, there was distal cyanosis and absence of distal pulses. The patient was subjected to an embolectomy with the suspicion of an acute arterial occlusion, but no emboli were found. Due to the possibility of a cutaneous necrosis caused by Acenocumarol, the medication is discontinued. The cutaneous lesions progressed and eight days after the failed embolectomy, a gangrene of the right foot was diagnosed. The patient did not accept amputation dying fourteen days after the first intervention.

A propósito un caso registrado, se resume la historia clínica y se revisa la literatura, dada la escasa frecuencia de esta complicación derivada del tratamiento por anticoagulantes orales. La necrosis cutánea es un evento adverso raro, pero serio, de la anticoagulación con derivados de acenocumarol o warfarina. Se comunicó por primera vez en 1943. La incidencia de la necrosis cutánea inducida por anticoagulantes orales es de 0,01 al 0,1 por ciento de los pacientes tratados. El número de casos publicados en el mundo es de aproximadamente 300, y menos de 100 en lengua inglesa en las últimas tres décadas. Este trabajo reporta el caso de una paciente que presenta necrosis cutánea en hombro izquierdo y pierna derecha.

Acute gangrene of the hand following accidental intra-arterial injection of phenergan

this is a report of 4 cases of gangrene of the hand following the accidental intra-arterial injection of phenergan. Patients and in three of the patients, the phenergan was given as an anti-emetic for vomiting accompanying malaria. In the fourth patient, it was given as a sedative for a psychiatric patient having a violent episode. in three of the patients who were alert at the time of the injection there was immediate burning sensation at the injection site down the forearm, pain in the hand, and numbness and tingling. In the fourth patient, who was less alert, there was an uncomfortable sensation in the forearm and hand. Two of the patients required amputation at the distal forearm. One patient required amputation at the interphalangeal joint. The fourth patient required amputation at the terminal phalanx of the index finger. Conclusions: inadvertent intra-arterial injection of phenergan is associated with severe complications