Warfarin induced necrosis would be one of the rare but serious complication of warfarin treatment. This normally occurs shortly after starting warfarin therapy in patients with protein C defiency. This is because Protein C is an innate anticogulant (vitamin K dependent) which play its role similar to other procogulant factors. Also, protein C requires Vitamin K for its carboxylation activity. And since warfarin initially reduces protein C levels faster than other coagulation factors, paradoxcially it would raise up blood's tendency to coagulate during starting of treatment. This may lead to skin necrosis and gangrene of limbs due to massive thrombosis. Due to this, heparin is normally given to patient for 3 to 5 days to counter this problem before warfarin full activily is achieved.
Similary, protein S deficiency may be affects in the same way as what happen to protein C deficiency.
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