Question 1

What is warfarin-induced skin necrosis?

Accepted Answer

Warfarin-induced skin necrosis is a rare but serious complication that occurs when starting warfarin blood thinner therapy, causing painful skin lesions and tissue death. It is caused by a temporary hypercoagulable state when warfarin initially depletes Protein C and Protein S levels faster than other clotting factors, creating paradoxical blood clots in small blood vessels. The Protein C Activity test is the most important test for identifying patients at risk before starting warfarin therapy.

Question 2

What causes warfarin-induced skin necrosis?

Accepted Answer

Warfarin-induced skin necrosis is caused by a temporary imbalance in blood clotting proteins when starting warfarin therapy. When you begin taking warfarin, it depletes Protein C and Protein S faster than it affects other clotting factors, creating a paradoxical pro-clotting state for the first few days of treatment. This temporary hypercoagulable condition causes small blood clots to form in the tiny blood vessels of your skin, cutting off blood supply and leading to painful skin lesions and tissue death, typically appearing within the first 3-10 days of starting warfarin.

Question 3

What is the best test for warfarin-induced skin necrosis?

Accepted Answer

The Protein C Activity test is the most important test for preventing warfarin-induced skin necrosis because it identifies patients with pre-existing Protein C deficiency who are at highest risk before starting warfarin therapy. This test measures the functional activity of Protein C, a natural anticoagulant that warfarin depletes rapidly in the first days of treatment. The Protein S Antigen, Free test is also essential as a companion screening tool, measuring another critical natural anticoagulant that warfarin affects. Testing for both protein deficiencies before starting warfarin allows your doctor to take preventive measures like bridging with heparin or choosing alternative blood thinners, which can prevent this potentially devastating complication.

Question 4

When should I get tested for warfarin-induced skin necrosis risk?

Accepted Answer

You should get tested before starting warfarin therapy if you have a personal or family history of unusual blood clots, if you have had multiple miscarriages, or if you are planning to begin warfarin treatment for any reason. Testing is particularly important if you are obese, female, or have had previous adverse reactions to blood thinners. Getting screened with Protein C and Protein S testing before your first warfarin dose allows your healthcare provider to identify if you are at high risk and implement protective strategies from day one, potentially preventing this serious complication entirely.

Question 5

What are the symptoms of warfarin-induced skin necrosis?

Accepted Answer

Warfarin-induced skin necrosis typically begins 3-10 days after starting warfarin with sudden, severe pain in areas with high fat content like the breasts, buttocks, thighs, or abdomen. The affected skin initially becomes red and swollen, then develops a purple or blue discoloration as blood flow is cut off. Within hours to days, painful blisters form and the skin develops black, dead tissue as necrosis progresses. The condition is extremely painful and can progress rapidly, requiring immediate medical attention to prevent extensive tissue loss and scarring.

Question 6

Who is at risk for warfarin-induced skin necrosis?

Accepted Answer

People with inherited Protein C or Protein S deficiency face the highest risk of warfarin-induced skin necrosis, with up to 90% of cases occurring in these individuals. Women are affected more frequently than men, particularly those who are overweight or obese, as the condition typically develops in areas with more fatty tissue. Patients receiving high initial doses of warfarin, those with cancer, and individuals taking warfarin after recent surgery also have elevated risk. Anyone starting warfarin for the first time should be considered potentially at risk, making pre-treatment screening valuable.

Question 7

What happens if warfarin-induced skin necrosis is left untreated?

Accepted Answer

Untreated warfarin-induced skin necrosis progresses rapidly to extensive tissue death, requiring surgical removal of dead tissue and often skin grafting procedures to repair the damage. The condition can lead to permanent disfigurement and severe scarring, particularly when it affects visible areas like the breasts. In severe cases, the extensive tissue damage can cause life-threatening infections, sepsis, or complications from massive tissue loss. Early recognition and immediate discontinuation of warfarin, along with aggressive wound care, are critical to limiting tissue damage and preventing these serious complications.

Question 8

Can warfarin-induced skin necrosis be diagnosed with a blood test?

Accepted Answer

Blood tests cannot diagnose warfarin-induced skin necrosis once it has developed, as the diagnosis is made by clinical examination of the characteristic skin changes. However, blood tests are essential for identifying patients at risk before starting warfarin therapy. The Protein C Activity test and Protein S Antigen test can detect deficiencies that dramatically increase your risk of developing this complication. Pre-treatment screening with these blood tests allows doctors to identify high-risk patients and implement preventive strategies like starting with lower warfarin doses, bridging with heparin, or choosing alternative anticoagulants entirely.

Question 9

How is warfarin-induced skin necrosis treated?

Accepted Answer

Treatment begins with immediately stopping warfarin and reversing its effects with vitamin K and fresh frozen plasma to restore normal clotting protein levels. Heparin, a different type of blood thinner that does not deplete Protein C or Protein S, is started to provide anticoagulation while warfarin is discontinued. Aggressive wound care includes pain management, debridement of dead tissue, and preventing infection. Severe cases may require surgical removal of necrotic tissue and skin grafting to repair the damage. Patients who develop this complication should never receive warfarin again and need alternative anticoagulation options like direct oral anticoagulants for future blood clot prevention.

Question 10

How can I prevent warfarin-induced skin necrosis?

Accepted Answer

Prevention starts with pre-treatment screening using Protein C Activity and Protein S Antigen blood tests to identify high-risk patients before starting warfarin. If you have a protein deficiency, your doctor can use bridging therapy with heparin or low molecular weight heparin during the first 5-10 days of warfarin treatment, which maintains anticoagulation while warfarin levels stabilize. Starting with lower initial doses of warfarin and increasing gradually rather than using high loading doses also reduces risk. For patients with known severe Protein C or S deficiency, choosing alternative anticoagulants like direct oral anticoagulants (DOACs) instead of warfarin eliminates the risk entirely.

Question 11

What can I do at home if I am taking warfarin?

Accepted Answer

While taking warfarin, monitor your skin daily for any new red, painful, or discolored areas, especially on your breasts, buttocks, thighs, and abdomen during the first two weeks of treatment. Take your warfarin exactly as prescribed at the same time each day, and attend all scheduled INR blood monitoring appointments to ensure your dose is appropriate. Maintain a consistent diet and avoid sudden changes in vitamin K intake from leafy greens, as this affects warfarin levels. If you notice any sudden skin pain, redness, or discoloration, contact your doctor immediately or go to the emergency room, as warfarin-induced skin necrosis requires urgent medical attention and cannot be safely managed at home.

Question 12

How’s this work?

Accepted Answer

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Question 13

How do I know which test to get?

Accepted Answer

In the test options, find the test you want.
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Question 14

When will my lab results be available?

Accepted Answer

Most test results will be available within 1–3 business days. Once they're ready, we'll send an email and text message to let you know.
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Question 15

Is it possible to make changes to my lab order if I made a mistake with the name, date of birth, or any other details?

Accepted Answer

Absolutely! We totally understand that errors can happen. No worries, we're here to help you.
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            There are no changes necessary if your address is wrong on the requisition though. We don’t mail anything out.
            Our lab requires an address to be listed to generate an order.

Question 16

Do you accept health insurance?

Accepted Answer

Only HSA & FSA is accepted.
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Question 17

Can I cancel my order?

Accepted Answer

Yes.
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Question 18

How can I find a lab location near me?

Accepted Answer

During the ordering process, you’ll be able to select a specific lab near you, with no strings attached!
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Warfarin Skin Necrosis Blood Test

What is Warfarin-induced skin necrosis?

What causes warfarin-induced skin necrosis?

What is the best test for warfarin-induced skin necrosis?

When should I get tested for warfarin-induced skin necrosis risk?

References

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