Warfarin necrosis pathology

Author: A/Prof Patrick Emanuel, Dermatopathologist, Auckland, New Zealand, 2013.

Warfarin necrosis is a paradoxical blood clotting occurring in patients on warfarin therapy. It occurs in approximately one in every 10,000 patients prescribed warfarin.

Histology of warfarin necrosis

In warfarin necrosis, sections show variable degrees of epidermal and dermal necrosis (figure 1). There are extensive intravascular thrombi within capillaries and venules (figures 2, 3). There remaining patent vessels are dilated.

Special studies of warfarin necrosis

None are needed.

Differential diagnosis of warfarin necrosis

Disseminated intravascular coagulation, coagulopathy – May be morphologically identical. Clinical correlation is essential.

Septic thrombi – Usually neutrophils and other inflammatory cells are also present. Special stains for microorganisms and correlation with blood culture results can be helpful.

Related information

Email Newsletter

Would you like to receive our dermatology updates by email?

SIGN UP

Submit your images

We're seeking high-quality photos of skin diseases.  

SUBMIT A PHOTO

Machine diagnosis

Watch DermNet's proposal to create a 'Skin Disease Image Recognition Tool' - winner of the 2017 'Clinicians' Challenge Active Award' by the NZ Ministry of Health and HiNZ.

Subscribe to our mailing list

* indicates required
DermNet NZ Newsletter