Therapy: Treatment of warfarin necrosis requires discontinuation of warfarin and initiation of heparin anticoagulation and supportive care with fresh-frozen plasma and vitamin K replace the lost protein C and protein S. Surgical debridement may be required, and one should be vigilant for any signs or symptoms of secondary infection. Therapy consists of proper replacement of vitamin K and supportive care. Menadione is a synthetic form vitamin K that can be given therapeutically.
Vitamin K deficiency in neonates and infants is diagnosed by an isolated elevation in the prothrombin time. The levels of the vitamin K–dependent clotting cofactors can each be measured, and vitamin K replacement should be administered to those who are deficient. Breast milk is not a strong source of vitamin K, and if the mother had previous children with vitamin K deficiency, the newborn should be given supplemental vitamin K. The best method for supplementation has yet to be determined, but it can be achieved with a onetime intramuscular injection or with oral replacement.
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