Question

A patient with deep vein thrombosis was started on a new drug. After 2 days, he presented with the given finding. Which of the following drugs is implicated in causing the above condition?

• A. Warfarin
• B. Heparin
• C. Dabigatran
• D. Rivarox

Answer 1

The Correct Option is A

In patients with deep vein thrombosis (DVT), anticoagulant therapy is crucial for preventing further clot formation and potential complications. The clinical scenario involves a patient who developed a specific condition after starting a new drug for DVT.

The condition mentioned often refers to an adverse reaction known as "Warfarin-induced skin necrosis." This reaction is a rare but serious complication associated with Warfarin, usually occurring within the first few days of therapy. The pathophysiology involves an imbalance between anticoagulant and procoagulant factors in the body. Specifically, Warfarin rapidly depletes protein C and protein S (natural anticoagulants), leading to a temporary hypercoagulable state and consequently skin necrosis or thrombosis in some patients.

To avoid this side effect, it is standard practice to overlap Warfarin with heparin (a faster-acting anticoagulant) during the initial days until the desired INR (International Normalized Ratio) levels are achieved.

Drug	Complication
Warfarin	Skin necrosis
Heparin	Thrombocytopenia
Dabigatran	Bleeding risk
Rivaroxaban	Bleeding risk

Among the given options, Warfarin is the anticoagulant drug typically associated with this specific adverse effect after initial days of treatment commencement.