Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Warfarin-induced Skin Necrosis After Valve Surgery

판막수술 후 항응고제 투여로 인한 피부괴사증

  • Moon, Seung-Chul (Department of Thoracic and Cardiovascular Surgery, Heart Center, Pundang CHA General Hospital, Pochon CHA University) ;
  • Lee, Gun (Department of Thoracic and Cardiovascular Surgery, Heart Center, Pundang CHA General Hospital, Pochon CHA University) ;
  • Lee, Hyeon-Jae (Department of Thoracic and Cardiovascular Surgery, Heart Center, Pundang CHA General Hospital, Pochon CHA University) ;
  • Ahn, Dae-Ho (Department of General Surgery, Pundang CHA General Hospital, Pochon CHA University) ;
  • Lim, Chang-Young (Department of Thoracic and Cardiovascular Surgery, Heart Center, Pundang CHA General Hospital, Pochon CHA University)
  • 문승철 (포천중문 의과대학교 분당차병원 흉부외과) ;
  • 이건 (포천중문 의과대학교 분당차병원 흉부외과) ;
  • 이헌재 (포천중문 의과대학교 분당차병원 흉부외과) ;
  • 안대호 (포천중문 의과대학교 분당차병원 일반외과) ;
  • 임창영 (포천중문 의과대학교 분당차병원 흉부외과)
  • Published : 1999.03.01
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Abstract

Warfarin-induced skin necrosis is a rare complication caused by transient hypercoagulable state. This state is a result of rapid decline of the protein C activity relative to that of coagulation factor II, IX, and X during initiation of oral anticoagulant therapy. We experienced a case of warfarin-induced skin necrosis involving both breasts in a patient who underwent double valve replacement 1 month before. Warfarin was replaced to a low- molecular weight heparin and the necrotic breast lesion was healed spontaneously. Low-dose warfarin was restarted and gradually increased, after which a low molecular weight heparin discontinued..

판막수술 후 반드시 투여해야 하는 항응고제로 인한 피부괴사증은 매우 드문 합병증으로 기전은 아직 확실히 밝혀지지는 않았지만 항응고제의 초기 투여시 제2, 9, 10 응고인자에 비해 C 단백질이 급격하게 감소하기 때문에 나타나는 일시적인 과응고 현상이다. 저자들은 다중판막 치환술 1개월 후에 양측 유방부위에 발생한 광범위한 피부괴사증을 경험하였다. 진단 즉시 \ulcorner파린 투여를 중단하고 저분자량의 헤파린으로 대치하였으며 피부괴사증은 5일 후 치유가 되었고 그 후 다시 와파린 투여를 저용량부터 시작하여 서서히 증량해가며 저분자량 헤파린 투여를 중단할 수 있었기에 문헌 고찰과 함께 보고하는 바이다.

Keywords

References

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