Does oral anticoagulant therapy (OAT) play a key role in triggering and maintaining calciphylaxis? A case report proposing a new etiological and nosological review

Calcific uremic arteriolopathy (CUA) is a rare but very serious morbid condition often observed during secondary hyperparathyroidism (HPTS). CUA affected patients by advanced chronic kidney disease (CKD). The Authors report a clinic case of a 63-year female diabetic patient on chronic hemodialysis that suddenly showed progressive necrotic cutaneous lesions similar to CUA. The status HPTS was in good control. This case led the authors to consider different etiological causes especially when vascular calcification. In the patient the main noxae could be the anticoagulant oral therapy (AOT) together smoking and inflammation induced by a severe malnutrition. Therapies proposals were sodium thiosulfate, based amino acids nutrition, an accurate and constant surgical medication of necrotic injuries. After the complete healing of skin lesions and good correction of nutritional status, the Authors asserted that OAT especially if associated with malnutrition smoking and diabetes can lead to necrotic lesions similar but not classifiable as calciphylaxis.