Purple toes and livido reticularis in a patient with cardiovascular disease taking coumadin. Cholesterol emboli associated with coumadin therapy

Park, S; Schroeter, Arnold L.; Park, Y S; Fortson, James K.

doi:10.1001/archderm.129.6.777

Cited by 13 publications

(5 citation statements)

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“…Associated symptoms can include a burning pain and intermittent numbness. 11,12,[42][43][44] In addition to the toes, this phenomenon has also been observed in the fingertips and palms. 11,12 The mechanism contributing to WIPTS is still speculative.…”

Section: Warfarin-induced Purple Toe Syndromementioning

confidence: 83%

“…42,45,46 The evidence for this is supported by skin biopsies of the affected region, which show the presence of cholesterol emboli occluding the dermal arteries, resulting in ischemia of the epidermis. 42 The risk factors of WIPTS include (a) male sex, (b) advanced age, and (c) patients with atherosclerosis on long-term anticoagulation. 44,45 Treatment involves warfarin cessation, and improvement can often be seen within 1 to 7 weeks.…”

Section: Warfarin-induced Purple Toe Syndromementioning

confidence: 94%

“…WIPTS can develop within 2 to 16 weeks after warfarin initiation, but there have been reports of a delayed onset of over a year after commencing warfarin therapy. 11,12,[42][43][44] WIPTS is often characterised by a sudden onset of a purple discoloration of the toes and sides of the feet that blanch with pressure. For the most part, the skin is intact, nonulcerated, and cool on palpation.…”

Section: Warfarin-induced Purple Toe Syndromementioning

confidence: 99%

“…Earlier case reports suggested warfarin had direct toxic effect on the capillaries, whereas more recent reports suggest it is due to cholesterol crystal embolization. [42][43][44] The current theory is that warfarin causes the embolization of cholesterol crystals from atherosclerotic plaques in the large arteries, which dislodge into the small vessels of the toes and fingers. The embolus causes vessel occlusion and ischemia.…”

Section: Warfarin-induced Purple Toe Syndromementioning

confidence: 99%

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Adverse Drug Reactions and Cutaneous Manifestations Associated With Anticoagulation

Gooderham

2017

J Cutan Med Surg

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Anticoagulants are amongst the most commonly prescribed medications worldwide. Although rare, localised and systemic drug reactions have been reported with anticoagulants that can lead to significant morbidity and mortality. Some of the first signs of drug reactions to anticoagulants are cutaneous changes that, when recognised early, can prevent significant complications. Dermatologists should be aware of these changes to make an early and accurate diagnosis. This is particularly important in instances of skin-induced necrosis caused by systemic toxicity to anticoagulants. This review discusses adverse drug reactions to the traditional anticoagulants, warfarin and heparin, and the newer direct oral anticoagulants (DOACs) such as the thrombin inhibitor, dabigatran, and the factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban. In particular, this review provides dermatologists with a framework for early diagnosis and management of patients with drug reactions to anticoagulants and alerts them to potential bleeding complications associated with minor procedures.

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Section: Warfarin-induced Purple Toe Syndromementioning

confidence: 83%

Section: Warfarin-induced Purple Toe Syndromementioning

confidence: 94%

Section: Warfarin-induced Purple Toe Syndromementioning

confidence: 99%

Section: Warfarin-induced Purple Toe Syndromementioning

confidence: 99%

See 2 more Smart Citations

Adverse Drug Reactions and Cutaneous Manifestations Associated With Anticoagulation

Gooderham

2017

J Cutan Med Surg

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“…111,112 The clinical changes show palpable purpura, livedo recularis, ulcerations, and purple toe. 113,114 Multiple cholesterol embolizations can be visualized with funduscopic examinations, and in skin biopsies. 115,116…”

Section: Cholesterol Embolimentioning

confidence: 99%