COUMADIN

 
From: john_g1@IX.NETCOM.COM (john)
I recently saw a 71 year old Chinese man with extensive ecchymoses on 
the arms and an extensive hx of senile pruritus. His ecchymoses are 
worrisome to the referring physician who wants to know whether or not 
to take him off of his coumadin or decrease the dose. He is 6 months 
status post-CVA. He has already been thru a course of Atarax,and 
Seldane. The problem is : Is this on the way to a purpura fulminans- 
should the coumadin be halted?? Would topical or systemic steroids be 
contra-inidicated with his already thin and fragile skin. any help 
would be appreciated.    John Guagenti,MD.   E-mail,or post to group.
 

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From: jeisner@sos.sos.net (Jerry Eisner)
If his mouth, legs and fingernails look ok without evidence of petechiae,
and if the arm ecchymoses are only on sun exposed areas, ie volar surfaces,
I would not see this as a cause to worry about purpura fulminans. If the
ecchymoses do not develop into actual hematomata or bleeding, I would use
other factors, such as stable hematocrit, lack of GI blood loss, acceptable
Protimes, etc to reassure me further.

I would not,however, take the hx of "senile pruritis" at face value unless I
had satisfied myself that other systemic and local causes of itching had
been considered.
Jerry Eisner