Skin necrosis and oral anticoagulant therapy: a review of the literature

In spite of the wide use of oral anticoagulant therapy, skin necrosis remains an infrequent complication. A thorough search of the earlier scientific literature in English revealed sporadic cases that cannot supply enough data about the nature of this rare phenomenon. More current articles have examined this complication with recently developed and more sophisticated hematologic tests. A summary and analysis of all reported cases (a total of 105) were undertaken, in an attempt to find a common denominator that would identify the possible cause(s) of the condition, thereby allowing for improved treatment. An imbalance between clotting factors, due to lack of protein C or factor VII, seems to be the most reasonable explanation for the phenomenon, although data to validate this theory are lacking.