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Venous thromboembolism is often encountered in cancer patients and is usually treated with heparin followed by warfarin. The main adverse effect of warfarin therapy is bleeding, but limb ischemia and gangrene can occasionally occur, usually in association with heparin-induced thrombocytopenia (HIT).
Investigators now describe the unique features of warfarin-associated venous limb gangrene in 10 cancer patients, all of whom had a negative serotonin-release assay for HIT antibodies. Patients had the following characteristics:
All had deep venous thrombosis and were receiving warfarin at the time of appearance of phlegmasia cerulea dolens (in 3 patients) and venous limb gangrene (in 7).
All had metastatic cancer, with primary lung cancer in four,…