Successful use of heparin and warfarin in the treatment of cholesterol crystal embolization

We report an 81-year-old male with cholesterol crystal embolization (CCE). He had been treated with warfarin for atrial fibrillation and an old cerebral infarction but had recurrence of cerebral infarction after warfarin was discontinued as treatment of CCE. Anticoagulation therapy by heparin in addition to warfarin was restarted, with the result that symptoms of cerebral ischemic damage did not recur and skin manifestations of CCE rapidly improved. These results suggest the possibility that heparin may be effective in the treatment of CCE, because CCE is not the result of pure embolization by cholesterol crystals but is a result of a combination with simultaneous thrombi.