Use of warfarin therapy at a target international normalized ratio of 3.0 for cutaneous polyarteritis nodosa.

Background: Cutaneous polyarteritis nodosa (CPN) is an uncommon disorder that can be difficult to manage effectively. We have previously suggested that CPN might be associated with the presence of anti-phosphatidylserine-prothrombin complex (anti-PS/PT) antibodies, members of the antiphospholipid antibody family.
Objective: To evaluate clinical manifestations and effective treatments of CPN.
Methods: We conducted a retrospective analysis of three patients with CPN who responded to warfarin therapy. IgG and IgM anti-PS/PT antibodies were measured with a specific enzyme-linked immunosorbent assay.
Results: There was a dramatic improvement in our three CPN patients following warfarin therapy adjusted to a target international normalized ratio (INR) of about 3.0. Active disease progression was halted by sustained warfarin therapy during which the patients experienced resolution of their skin manifestations.
Limitations: A small number of cases were studied and the study design was retrospective.
Conclusion: We propose that warfarin therapy at a target INR of roughly 3.0 could be effective for treating patients with CPN. We further believe that treatment with warfarin led to the effective attenuation of anti-PS/PT antibodies related to prothrombin, and improved the symptoms in our CPN patients.
(Copyright © 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)