Managing anticoagulation in a patient with Calciphylaxis and mechanical valve: a therapeutic dilemma

Figures

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  Figure 1. Progression of abdominal wound from necrotic ulceration on warfarin to stabilization after transition to subcutaneous unfractionated heparin (UFH). The wound progression began with image a, showing extensive necrotic ulcers while the patient was on warfarin. Two weeks later (image B), there was worsening ulceration and increased tissue scaling, prompting a switch to subcutaneous heparin. One month later (image C), the wound stabilized without further ulceration or deepening. By two months (image D), the wound remained stable with minimal superficial bleeding. The patient was later admitted with sepsis (image E), likely from wound infection, requiring surgical debridement. Image F shows the wound pre-debridement, and image G shows the immediate post-debridement bed. Image H (10 days later) revealed reinfection, necessitating a second debridement (image I).

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  Figure 2. Progression of left flank wound over the course of subcutaneous unfractionated heparin (UFH) therapy. The left flank lesion initially appeared as a small, dark, indurated patch (image a). By the time of transition from warfarin to subcutaneous heparin (image B), the lesion had progressed to an ulcer with central necrosis and surrounding erythema, indicating early tissue breakdown. One month after switching to subcutaneous heparin (image C), the wound showed stabilization with well-demarcated edges and no further deepening. At two months (image D), there was marked improvement, with healthy granulation tissue replacing necrotic areas and an overall reduction in wound size, suggesting a favorable healing trajectory under the adjusted anticoagulation regimen.