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The patient on the left had a deep vein thrombosis, while the patient on the right had rheumatic mitral stenosis with atrialfibrillation.
A rare and unpredictable complication of oral anticoagulation therapy, affecting women more than men. The skin necrosistypically appears on the third to fifth day of therapy, but always within the first two weeks. Frequent areas of involvement are the buttocks, thighs, andbreasts. Fingers, hands, neck, and face are typically spared. The pathogenesis remains speculative, but it clearly is not dose-related. Associated congenitalor acquired coagulation deficiencies have been identified in a minority of cases. Besides discontinuing anticoagulation therapy, management may include useof Vitamin K, heparin, fibrinolytic agents, or surgical debridement of gangrenous tissue. Depending on the extent and degree of necrosis, the lesionsmay heal on their own.
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