{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T09:21:42Z","timestamp":1778923302031,"version":"3.51.4"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2017,1,1]],"date-time":"2017-01-01T00:00:00Z","timestamp":1483228800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2017,1,20]],"date-time":"2017-01-20T00:00:00Z","timestamp":1484870400000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,1]]},"abstract":"ABSTRACT<\/jats:title>\n \n INTRODUCTION:<\/jats:title>\n Warfarin anticoagulation of oncologic patients with DVT may paradoxically progress to phlegmasia cerulea dolens and limb gangrene, due to cancer-associated disseminated intravascular coagulation. This case report, written in line with the SCARE criteria, endorses venous thrombectomy in selected patients to attempt limb salvage. A young woman\u2019s warfarin associated acute ileofemoral phlegmasia that developed over cervical cancer radiation therapy induced DVT, was successfully resolved by clot removal. Extracting venous thrombus at the onset, while still as unorganized masses, preserves ambulation and prevents post-thrombotic syndrome development, an improvement of quality of life especially significant for oncologic patients with limited life-expectancy.<\/jats:p>\n <\/jats:sec>\n \n PRESENTATION OF CASE:<\/jats:title>\n A 34 years old female, with history of stage 3 cervical cancer following radiation therapy, was admitted in regards to left lower limb painful pitting oedema with cramps. Doppler scan revealed a left ileofemoral DVT. She was set on LMWH, but on fourth day of warfarin co-administration, phlegmasia cerulea dolens developed. An emergency venous thrombectomy with fasciotomy was performed. Postoperatively, dry foot gangrene developed, which dictated transmetatarsal amputation. The patient was discharged after 2 months of inpatient treatment, preserving ambulation.<\/jats:p>\n <\/jats:sec>\n \n DISCUSSION:<\/jats:title>\n Venous thrombectomy (with fasciotomy) in oncologic phlegmasia, \u00b1 serial debridement, becomes an attractive opportunity for limb salvage when feasible at acute presentation, available in a limited resource setting.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION:<\/jats:title>\n Due to severe procoagulant\/anticoagulant balance disturbances in cancer patients\u2019 warfarin-bridged for DVT, phlegmasia onset should not defer surgical approach, unless a rapid response to conservative treatment.<\/jats:p>\n <\/jats:sec>\n \n Highlights<\/jats:title>\n <\/jats:sec>","DOI":"10.1016\/j.ijscr.2017.01.047","type":"journal-article","created":{"date-parts":[[2017,1,23]],"date-time":"2017-01-23T13:31:02Z","timestamp":1485178262000},"page":"66-69","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Warfarin associated venous limb gangrene in cancer-related DVT (case report)"],"prefix":"10.1097","volume":"32","author":[{"given":"Vladimir","family":"Cojocari","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dumitru","family":"Casian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugen","family":"Gutu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-19-20260114","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.chest.2015.11.026","article-title":"Antithrombotic therapy for VTE disease. Chest Guideline and Expert Panel Report","volume":"149","author":"Kearon","year":"2016","journal-title":"Chest"},{"key":"R2-19-20260114","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1002\/ajh.10181","article-title":"Venous limb gangrene during overlapping therapy with warfarin and a direct thrombin inhibitor for immune heparin-induced thrombocytopenia","volume":"71","author":"Smythe","year":"2002","journal-title":"Am. J. Hematol"},{"key":"R4-19-20260114","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1182\/blood-2015-01-622787","article-title":"Warfarin-induced venous limb ischemia\/gangrene complicating cancer: a novel and clinically distinct syndrome","volume":"126","author":"Warkentin","year":"2015","journal-title":"Blood"},{"key":"R6-19-20260114","first-page":"38","article-title":"Warfarin-induced venous limb gangrene","volume":"5","author":"Hostetler","year":"2012","journal-title":"J. Clin. Aesthet. 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North Am"},{"key":"R10-19-20260114","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg"},{"key":"R11-19-20260114","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.ijsu.2016.08.014","article-title":"The SCARE Statement: consensus-based surgical case report guidelines","volume":"34","author":"Agha","year":"2016","journal-title":"Int. J. Surg"},{"key":"R12-19-20260114","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.jvs.2005.09.036","article-title":"Technique of contemporary iliofemoral and infrainguinal venous thrombectomy","volume":"43","author":"Comerota","year":"2006","journal-title":"J. Vasc. Surg"}],"container-title":["International Journal of Surgery Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2210261217300500?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2210261217300500?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/01612930-201732000-00019","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T13:45:11Z","timestamp":1768398311000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01612930-201732000-00019"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1]]},"references-count":10,"journal-issue":{"issue":"C","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.1016\/j.ijscr.2017.01.047","relation":{},"ISSN":["2210-2612"],"issn-type":[{"value":"2210-2612","type":"print"}],"subject":[],"published":{"date-parts":[[2017,1]]}}}