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Rare, Occasionally Lethal Complication of Anticoagulant Therapy

Robert M. Nalbandian, MD; Ivan J. Mader, MD; John L. Barrett, MD; James F. Pearce, MD; Edson C. Rupp, MD

JAMA. 1965;192(7):603-608.

Abstract
A rare complication of coumarin-congener anticoagulant therapy characterized by a sequence of skin lesions (petechiae, ecchymoses, and hemorrhagic infarcts) in random sites is well documented in the foreign literature and, as far as we know, is almost unknown in the American literature. These skin lesions are manifest between the third and the tenth day of anticoagulant therapy, 90% occurring within the third to the sixth day. These alarming lesions are associated only with the use of coumarin congeners, bishydroxycoumarin (Dicoumarol) being involved most frequently. Sodium heparin has never been implicated. A pathogenesis is proposed which nicely accommodates the morphologic features of this dermatopathy. However, unresolved, enigmatic clinical aspects remain.

Author Affiliations
From the departments of pathology (Dr. Nalbandian), surgery (Dr. Barrett), internal medicine (Drs. Mader, Pearce, and Rupp), and medical education (Dr. Mader), William Beaumont Hospital, Royal Oak, Mich, and the departments of pathology (Dr. Nalbandian) and internal medicine (Dr. Mader), School of Medicine, Wayne State University, Detroit.

Footnotes
Reprint requests to 3601 W 13 Mile Rd, Royal Oak, Mich 48073 (Dr. Nalbandian).

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