JAN KOCH-WESER, M.D.
The only frequent adverse reaction during therapy with oral anticoagulants is bleeding due to depression of vitamin K-dependent hepatic clotting proteins. Untoward effects not related to the desired pharmacologic action of coumarin derivatives are unusual and generally benign events such as gastrointestinal dysfunction, hypersensitivity dermatitides, drug fever, and alopecia. Only one serious complication remains poorly understood: coumarin necrosis of skin and subcutaneous tissue. Widely reported in Europe (1-10) it has received little attention in English-speaking countries (11-14) and is still being misinterpreted as a hemorrhagic effect.
Although clinical use of bishydroxycoumarin began in 1940, coumarin necrosis was not recognized until
KOCH-WESER J. Coumarin Necrosis. Ann Intern Med. ;68:1365–1367. doi: 10.7326/0003-4819-68-6-1365
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Published: Ann Intern Med. 1968;68(6):1365-1367.
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