Journal de recherche clinique et expérimentale en dermatologie
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Is Warfarin Usage A Risk Factor for Cutaneous Calciphylaxis? A Retrospective Analysis

Kimberly A Tefft, Jonathan Andrews, Jason B Lee and Rakesh Gulat

Currently the pathogenesis of cutaneous calciphylaxis, also known as calcemic uremic arteriolopathy, is poorly understood. We sought to evaluate potential risk factors for cutaneous calciphylaxis (CC), specifically warfarin usage prior to CC diagnosis, other anticoagulant usage prior to CC diagnosis, an elevated serum calcium level, an elevated serum phosphate level, a serum calcium and phosphate product greater than 50, hyperparathyroidism, and a history of chronic (stage III-V) kidney disease. We performed a retrospective analysis of all histopathologically confirmed cases of cutaneous calciphylaxis diagnosed at Thomas Jefferson University Hospital between January 1st 1990 and March 1st 2010. Of the thirteen study patients, five (38%) patients had a history of warfarin use, 12 (93%) of patients had elevated intact parathyroid hormone levels, and 12 (93%) of patients suffered from chronic (stage III-V) kidney disease. Of those that are deceased, median and average survival since original cutaneous calciphylaxis diagnosis was 2 months (range 0-165 months). The constructed Kaplan – Meier survival rate suggests a rapid decline in survival rate during the first sixth months following CC diagnosis. Limitations of our study include the small patient population size, largely due to the rarity of cutaneous calciphylaxis, and the study’s retrospective nature.