Key result
Discontinuation of warfarin and initiation of apixaban resulted in complete resolution of leukocytoclastic vasculitis and no additional thromboembolic events at six weeks.
Why the study?
Warfarin is a rare cause of cutaneous small vessel leukocytoclastic vasculitis with sparse literature to date, posing management challenges when anticoagulation is needed for left ventricular thrombus.
Case Report (n=1)
No
Apixaban may serve as a safe and effective alternative to warfarin for treating left ventricular thrombus in patients who develop warfarin-induced leukocytoclastic vasculitis.
May warrant LCV evaluation during warfarin therapy in LV thrombus patients; extends sparse case reports but leaves optimal management open.
Cutaneous small vessel leukocytoclastic vasculitis (LCV) is isolated to the dependent areas of the skin. LCV can be induced by pharmaceutical drugs, and management requires abrupt discontinuation of the offending drug. Warfarin is a rare medication to cause LCV, with sparse literature to date. Here, we present a case of warfarin-induced LCV, complicated by a patient's comorbid left ventricular thrombus, and successful treatment with discontinuation of warfarin and replacement with a direct oral anticoagulant (apixaban).
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Nader et al. (2023) conducted a case report in Warfarin-induced leukocytoclastic vasculitis and left ventricular thrombus (n=1). Apixaban vs. Warfarin (prior therapy) was evaluated on Resolution of rash and absence of thromboembolic events. Discontinuation of warfarin and initiation of apixaban resulted in complete resolution of leukocytoclastic vasculitis and no additional thromboembolic events at six weeks.
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