A Case Report on Warfarin Induced Skin Necrosis: Drug-drug Interaction or Inappropriate Therapy

Introduction: Warfarin is one of the most frequently prescribed oral anticoagulant. Necrosis and/or gangrene ofskin and other tissues is an uncommon but serious risk associated with warfarin. The incidence of warfarin inducedtissue necrosis is about 0.01 % to 0.1%.Case description: A 62-year-old male presented to emergency with a complaint of skin discoloration and edema onleft lower limb diagnosed as warfarin induced skin necrosis. He had an episode of hemiparesis 20 days back for whichhe was started on oral warfarin along with other medications. On diagnosis warfarin was stopped and fresh frozenplasma (FFP) was given along with vitamin K. Due to progressing tissue necrosis, above knee limb amputation wasdone. We assume that an interaction between rosuvastatin and warfarin or possibly lack of adequate bridge therapywith heparin resulted in this complication.Conclusion: Warfarin induced skin necrosis is a known early complication of the therapy. Though late onsetappearance of this event is rare but not unknown. Bridging therapy with heparin and avoiding use of interactingdrugs concomitantly could prevent many such reactions.

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Metric Charcteristics of Sit-to-stand Tests in Patients After Lower-limb Amputation

Case Medical Research ◽

10.31525/ct1-nct04293237 ◽

2020 ◽

Author(s):

Keyword(s):

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Sit To Stand

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Prostheses and orthoses. Factors to be considered when specifying a prosthesis for a person who has had a lower limb amputation

10.3403/30178636 ◽

2009 ◽

Keyword(s):

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation

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Prostheses and orthoses. Factors to be included when describing physical activity of a person who has had a lower limb amputation(s) or who has a deficiency of a lower limb segment(s) present at birth

10.3403/30178633u ◽

2015 ◽

Keyword(s):

Physical Activity ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Limb Segment

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Prostheses and orthoses. Factors to be included when describing physical activity of a person who has had a lower limb amputation(s) or who has a deficiency of a lower limb segment(s) present at birth

10.3403/30178633 ◽

2009 ◽

Keyword(s):

Physical Activity ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Limb Segment

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Treatment Strategies Against Diabetic Foot Ulcer: Success so far and Road Ahead

Current Diabetes Reviews ◽

10.2174/1573399816999201102125537 ◽

2020 ◽

Vol 16 ◽

Author(s):

Ankit Awasthi ◽

Sachin Kumar Singh ◽

Bimlesh Kumar ◽

Monica Gulati ◽

Rajesh Kumar ◽

...

Keyword(s):

Lower Limb ◽

Diabetic Foot ◽

Treatment Strategies ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Arterial Disease ◽

Current Status ◽

Limb Amputation ◽

Bibliographic Databases ◽

Inflammatory Phase

Background: Diabetic foot ulcer (DFU) is one of the leading complications of type-2 diabetes mellitus. It isassociated with neuropathy and peripheral arterial disease of the lower limb in patients with diabetes. Basically, there are four stages of wound healing namely hemostasis phase, inflammatory phase, proliferative phase and maturation phase. In case of DFU, all these stages are disturbed which lead to delay in healing and consequently to lower limb amputation. Traditionally the dosage forms like tablets, creams, ointments, gels and capsules have been used for the treatment of diabetic foot ulcer from many years. Introduction: In this review the global prevalence as well as etiopathogenesis related to diabetic foot ulcer has been discussed. Potential role of various synthetic and herbal drugs as well as their conventional dosage form for the effective management of diabetes foot ulcer has been highlighted. Methods: Structured search of bibliographic databases for previously published peer-reviewed research papers was explored and data was culminated in terms of various approaches that are used for the treatment of diabetic foot ulcer. Results: About 142 papers including both, research and review articles, were included in this review in order to produce a comprehensive as well as readily understandable article. A series of herbal and synthetic drugs have been discussed along with their current status of treatment in terms of dose and mechanism of action. Conclusion: DFU has become one of the most common complications in patients having more than ten years of diabetes. Hence, understanding the root cause and its successful treatment is a big challenge because it depends upon multiple factors such as judicious selection of drug as well as proper control of blood sugar level. Most of the drugs that have been used so far either belong to the category of antibiotics, antihyperglycaemics or, they have been repositioned. Moreover, in clinical practice, much focus has been given towards dressings that have been used to cover the ulcer. The complete treatment of DFU is still a farfetched dream to be achieved and it is expected that a combination therapy of herbal and synthetic drug with multiple treatment pathway could be able to overcome the disease.

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P90 PERCEIVE: PrEdiction of Risk and Communication of outcome following major lower limb amputation - a collaboratIVE study

BJS Open ◽

10.1093/bjsopen/zrab032.089 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

B Gwilym ◽

C Waldron ◽

E Thomas-Jones ◽

P Pallmann ◽

R Preece ◽

...

Keyword(s):

Risk Prediction ◽

Lower Limb ◽

Health Care Professionals ◽

Healthcare Professionals ◽

Demographic Data ◽

Collaborative Study ◽

Lower Limb Amputation ◽

Research Network ◽

Limb Amputation ◽

Prediction Tools

Abstract Introduction Major Lower Limb Amputation (MLLA) is a life changing event with significant morbidity and mortality. Inaccurate risk prediction can lead to poor decision making, resulting in delay to definitive surgery, or undertaking amputation when not in the patient’s best interest. We aim to answer: In adult patients undergoing MLLA for chronic limb threatening ischaemia or diabetes, how accurately do health care professionals prospectively predict outcomes after MLLA, and how does this compare to existing prediction tools? Methods A multicentre prospective observational cohort study is being delivered through the Vascular and Endovascular Research Network. Dissemination was via an existing network of contacts and social media. Consecutive data will be collected for seven months from site launch date, including demographic data and pre-operative outcome predictions from surgeons, anaesthetists, and allied healthcare professionals. Follow-up data will comprise 30-day (mortality, morbidity, MLLA revision, surgical site infection, and blood transfusion) and 1-year (mortality, MLLA revision and ambulation). The accuracy of surgeons’ predictions will be evaluated and compared to pre-existing risk prediction scoring tools. Results PERCEIVE launched on 01/10/2020 with 23 centres (16 UK, 7 international) registered to collect data. 50 other centres (27 UK, 23 international) have expressed interest/are pursuing local audit/ethical approval. We aim to collect data on clinicians estimate of outcomes for over 500 patients. Discussion This study will utilise a trainee research network to provide data on the accuracy of healthcare professionals’ predictions of outcomes following MLLA and compare this to the utility of existing prediction tools in this patient cohort.

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