Extensive dermatitis due to warfarin sodium (coumadin).

W ARFARIN SODIUMI, 3-(alpha-acetonylbelizyl) -4-hydroxyeoumarin sodium, (Coumadini) is onie of several popular anticoagulant agents used to delay intravascular clotting by depressioni of the prothrombin level of the blood. This drug is often used iu instances in which there is an acute throinbophlebitis, pulmoniary and peripheral embolism, eoronary and cerebral thrombosis, and it is employed prophylactically to prevent arterial einbolizationi and thrombosis.1-4 Excessive lowering of eirculatinig prothromnbin with spontaneous hemorrhage is the important complication in the use of this prothrombinemic agent.4' 5 Five per cent of the patients who receive anticoagulant therapy develop mild hemorrhagic nmanifestations such as hematuria, hemoptysis, epistaxis, anid ecehymosis. These are readily controlled by the administration of vitamiin K,. Approximately 2 per cent of patients develop more severe hemorrhagic phenomena such as hemarthrosis, gastrointestinal, cerebral, or subarachnoid hemorrhage, or purpura. These conmplications demand early recognition and the pronmpt use of vitamiin K, or blood,transfusion."-" Sheps and Gifford9 first reported anl allergic manifestation of warfarini sodium. In that instance, transient urticaria appeared in a 30-year-old man, 40 miniutes after the oral administration of 50 iug. of warfarin sodiunm. Subsequently, bishydroxyeouinarin was adiministered without reaction. Extensive dermatitis has not previously been reported as a complication of warfariii sodium therapy.