Venous limb gangrene during warfarin treatment of cancer-associated deep venous thrombosis.

Abstract:

BACKGROUND:The cause of cancer-associated venous limb gangrene is unknown but could paradoxically be due to warfarin. OBJECTIVE:To determine the pathogenesis of venous gangrene in a patient with cancer. DESIGN:Case report. SETTING:University hospital in Ontario, Canada. PATIENT:66-year-old woman with metastatic lung cancer and deep venous thrombosis. MEASUREMENTS:Levels of vitamin K-dependent factors, additional coagulation factors, and thrombin-antithrombin complexes (marker of thrombin generation). RESULTS:During warfarin use, venous limb gangrene developed when the international normalized ratio (INR) reached 6.0 (therapeutic range, 2.0 to 3.0); at this time, the level of protein C (a vitamin K-dependent natural anticoagulant) was severely reduced, but thrombin-antithrombin complexes remained markedly elevated. The supratherapeutic INR was explained by the greatly reduced levels of factor VII, which correlated closely with protein C levels; therefore, the high INR was a surrogate marker for severely reduced protein C activity. CONCLUSION:Warfarin may contribute to the pathogenesis of cancer-associated venous limb gangrene by leading to severe depletion of protein C while at the same time failing to reduce thrombin generation.

journal_name

Ann Intern Med

authors

Warkentin TE

doi

10.7326/0003-4819-135-8_part_1-200110160-00009

subject

Has Abstract

pub_date

2001-10-16 00:00:00

pages

589-93

issue

8 Pt 1

eissn

0003-4819

issn

1539-3704

pii

200110160-00009

journal_volume

135

pub_type

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