Final answer:
Warfarin skin necrosis is a serious condition typically caused by protein C deficiency, leading to painful localized skin necrosis after starting warfarin therapy. It is associated with risk factors like thrombophilia and liver disease, and prevention includes using low initial doses of warfarin and careful monitoring.
Step-by-step explanation:
The condition associated with warfarin skin necrosis primarily occurs due to the deficiency of protein C, which is a natural anticoagulant. Individuals with this deficiency may develop rapidly progressing skin necrosis when they begin warfarin therapy. It is a severe complication characterized by localized skin necrosis, which usually appears between the third and tenth day of therapy. Skin necrosis manifests as a painful, red to purplish area that subsequently turns black as the skin dies. The condition may be preceded by petechial rashes, and if not recognized early and managed promptly, it can lead to significant morbidity and sometimes mortality.
Risk factors for warfarin-induced skin necrosis include a history of thrombophilia, high initial doses of warfarin, and certain underlying medical conditions such as liver disease, deficiency of protein C or S, and antiphospholipid syndrome. Key in preventing this condition is starting with low doses of warfarin and ensuring consistent monitoring of INR levels to avoid supratherapeutic dosing. In cases where treatment is indicated for individuals with protein C deficiency, heparin is often used before transitioning to warfarin to minimize the risk.