{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T13:59:20Z","timestamp":1761487160358},"reference-count":12,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2004,5,20]],"date-time":"2004-05-20T00:00:00Z","timestamp":1085011200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2004,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>A 53\u2010year\u2010old man with lung adenocarcinoma developed pulmonary embolism and bilateral popliteal venous thrombosis. Treated with intravenous unfractionated heparin and discharged home on warfarin, he returned a week later with extending thrombosis. Treatment with heparin followed by warfarin was reinitiated. Twenty\u2010four hours following the re\u2010administration of warfarin, the patient's INR increased to 14.5. The platelet count dropped by more than 50%, and he developed venous limb gangrene of the left leg and skin necrosis of the right leg. Heparin\u2010induced thrombocytopenia was ruled out, and coagulation studies showed a severe depletion of protein C as well as increased thrombin generation. The patient was transfused with fresh frozen plasma, and vitamin K was given. Heparin was continued, and after 4 weeks, the patient improved markedly showing only minimal necrosis of the toes. Venous limb gangrene is a major complication associated with warfarin therapy. Its pathogenesis is explained by a transient hypercoagulable state produced by protein C depletion that leads to microvascular thrombi progressing to venous limb gangrene. The present case emphasizes the importance of careful anticoagulation with heparin followed by slow initiation of low\u2010dose warfarin, in order to minimize thrombotic complications. Am. J. Hematol. 76:176\u2013179, 2004. \u00a9 2004 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/ajh.20060","type":"journal-article","created":{"date-parts":[[2004,5,20]],"date-time":"2004-05-20T22:05:33Z","timestamp":1085090733000},"page":"176-179","source":"Crossref","is-referenced-by-count":16,"title":["Warfarin\u2010induced limb gangrene in the setting of lung adenocarcinoma"],"prefix":"10.1002","volume":"76","author":[{"given":"Liviu","family":"Klein","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angel","family":"Galvez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oana","family":"Klein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Chediak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2004,5,20]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1974.tb14458.x"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200006293422604"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1994.34594249047.x"},{"issue":"1","key":"e_1_2_1_5_2","first-page":"51","article-title":"Comparison of two PF4\/heparin ELISA assays for the laboratory diagnosis of heparin\u2010induced thrombocytopenia","volume":"25","author":"Izban KF","year":"1999","journal-title":"Semin Thromb Hemost"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1646768"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-127-9-199711010-00005"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-8652(199909)62:1<44::AID-AJH7>3.0.CO;2-F"},{"key":"e_1_2_1_9_2","first-page":"147","article-title":"The prothrombotic state in cancer","volume":"17","author":"Luzzato G","year":"1990","journal-title":"Semin Oncol"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.4.310"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-127-9-199711010-00012"},{"key":"e_1_2_1_12_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-135-8_Part_1-200110160-00009"},{"key":"e_1_2_1_13_2","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1055\/s-0038-1657628","article-title":"Warfarin and heparin\u2010induced skin necrosis and the purple toe syndrome: infrequent complications of anticoagulant treatment","volume":"78","author":"Sallah S","year":"1997","journal-title":"Thromb Haemost"}],"container-title":["American Journal of Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fajh.20060","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajh.20060","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,16]],"date-time":"2023-11-16T17:12:05Z","timestamp":1700154725000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ajh.20060"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,5,20]]},"references-count":12,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2004,6]]}},"alternative-id":["10.1002\/ajh.20060"],"URL":"https:\/\/doi.org\/10.1002\/ajh.20060","archive":["Portico"],"relation":{},"ISSN":["0361-8609","1096-8652"],"issn-type":[{"value":"0361-8609","type":"print"},{"value":"1096-8652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,5,20]]}}}