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Coumarin Necrosis Associated with Hereditary Protein C Deficiency

WILLIAM G. McGEHEE, M.D.; THOMAS A. KLOTZ, M.D.; DAVID J. EPSTEIN, M.D.; and SAMUEL I. RAPAPORT, M.D.
[+] Article and Author Information

Grant support: in part by grant HL 27234-03 from the Public Health Service.

▸Requests for reprints should be addressed to William G. McGehee, M.D.; University of Southern California School of Medicine; 2025 Zonal Avenue; Los Angeles, CA 90033.


University of Southern California School of Medicine, Los Angeles, California; and the University of California at San Diego School of Medicine, San Diego, California


Ann Intern Med. 1984;101(1):59-60. doi:10.7326/0003-4819-101-1-59
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This excerpt has been provided in the absence of an abstract.

Coumarin skin necrosis is an uncommon but well recognized complication of oral anticoagulant therapy (1). We have discovered that a patient with coumarin penile necrosis whose case was previously reported (2) has hereditary deficiency of protein C. Our observation provides insight into the mechanism of this paradoxical thrombotic complication of anticoagulant therapy.

A 33-year-old man was hospitalized for recurrent deep vein thrombosis of the legs. Heparin and warfarin therapy had been given previously without complications. He was initially treated with intravenous heparin; warfarin was begun on the eighth day. Forty-eight hours after the first of two 20-mg doses, he awoke

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