Log in with your email address username.


Important notice

doctorportal Learning is on the move as we will be launching a new website very shortly. If you would like to sign up to dp Learning now to register for CPD learning or to use our CPD tracker, please email support@doctorportal.com.au so we can assist you. If you are already signed up to doctorportal Learning, your login will work in the new site so you can continue to enrol for learning, complete an online module, or access your CPD tracker report.

To access and/or sign up for other resources such as Jobs Board, Bookshop or InSight+, please go to www.mja.com.au, or click the relevant menu item and you will be redirected.

All other doctorportal services, such as Find A Doctor, are no longer available.

Warfarin-induced skin necrosis following recommencement of warfarin after perioperative Prothrombinex-VF

- Featured Image

Clinical record

A 62-year-old man with thrombophilia was receiving warfarin for recurrent venous and arterial thrombosis, and had a known 48 mm diameter infrarenal abdominal aortic aneurysm (AAA). He presented with collapse at home after 2 days of increasing pain in the left flank. A left-sided retroperitoneal haematoma was identified by computed tomography angiography. Increasing abdominal pain and a decline in haemoglobin levels from 125 g/L to 88 g/L made it necessary to transfer the patient urgently to theatre for exploration and open repair of a presumed ruptured AAA.

The patient had been taking 1.5 mg warfarin each day for 20 years without complication. He was known to be heterozygous for both the factor V Leiden and the prothrombin G2021A mutations. He was a current smoker with a 40-pack-year history who also had mild rheumatoid arthritis, insulin-dependent type 2 diabetes mellitus, stage 3A chronic kidney disease, moderate aortic stenosis and hypertension.

Before surgery, anticoagulation with therapeutic warfarin (international normalised ratio [INR] 2.5) was reversed according to our unit protocol with 5000 IU Prothrombinex-VF (CSL Behring Australia). A posterior rupture of the AAA was confirmed during the operation. Sodium heparin (5000 U) was administered before aortic cross-clamping, and its action was fully reversed at the end of surgery with 50 mg protamine…