Purple Toes and Livido Reticularis in a Patient With Cardiovascular Disease Taking Coumadin

SangKun, Park

doi:10.1001/archderm.1993.01680270121019

Cited by 14 publications

(11 citation statements)

References 10 publications

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“…There are few reports published of this effect, and when reported, occurs relatively quickly after starting warfarin. [1][2][3][4][5][6][7][8][9][10] In addition, it is unclear, based on these reports, what therapy should be used in patients needing continued anticoagulation. We encountered an unusual case of purple toes associated with warfarin, first noticed more than 1 year after a second course of warfarin therapy, which was successfully treated with fondaparinux substitution.…”

Section: Introductionmentioning

confidence: 99%

Late Onset Purple Toe Syndrome With Warfarin Successfully Treated With Fondaparinux

Rindone

Mellen²,

Eliason³

2011

American Journal of Therapeutics

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Purple toe syndrome is a rarely reported adverse effect of warfarin. In all described cases, the syndrome occurred relatively quickly after initiation of warfarin with little recommendation for treatment in patients needing continued anticoagulation. We encountered a patient who developed purple toes after 1 year of warfarin therapy. The warfarin was stopped, and fondaparinux was substituted with prompt resolution of all his symptoms. This is the first case describing late onset purple toe syndrome with warfarin with successful substitution with fondaparinux.

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Section: Introductionmentioning

confidence: 99%

Late Onset Purple Toe Syndrome With Warfarin Successfully Treated With Fondaparinux

Rindone

Mellen²,

Eliason³

2011

American Journal of Therapeutics

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“…[110] When vessel occlusion is isolated to the upper extremity, fibromuscular dysplasia [111] and emboli from vascular lesions in the anatomic snuffbox [112] should be considered. [115] Like warfarin, thrombolytics (i.e. [113] Statins (HMG-CoA reductase inhibitors) have been shown to decrease the incidence of embolism from thoracic aortic plaques visible on TEE.…”

Section: Peripheral Pulses Normalmentioning

confidence: 99%

The Purple Digit

Brown

Zirwas

English

2010

American Journal of Clinical Dermatology

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The acute onset of purple digits is a concerning manifestation and may represent underlying, potentially life-threatening disease. Correctly identifying the etiology of purple digits is essential to proper management, and can aid in the diagnosis of systemic disease. Multiple causes of purple digits and significant overlap in clinical presentation can make diagnosis difficult. Despite the various causes of acute purple digits in the published literature, an algorithmic approach to the evaluation and management of the most common and alarming etiologies has yet to be established. The initial step in evaluating a patient with purple digits is to determine if the cause is associated with hypoxemia or trauma. If the patient is in a stable condition, the dermatologist needs to determine if the process could be related to cold exposure such as Raynaud phenomenon, acrocyanosis, pernio, cryoglobulinemia or frostbite. If the disease occurs independent of temperature, physical examination and histological evaluation of the skin is recommended. The lack of peripheral pulses are concerning for acute arterial thrombosis from peripheral vascular disease or arterial embolism. Non-blanching skin changes on the digit that lack inflammation and microthrombosis most likely represent a bleeding or platelet abnormality; however, if microthrombi are identified a more life-threatening processes such as purpura fulminans or embolic phenomenon may be occurring. Evidence of blood vessel inflammation suggests a leukocytoclastic vasculitis. The patient with a purple blanching digit and normal pulses requires an extensive historical review to help determine the cause. This review presents an algorithmic approach to assist in the evaluation and management of the purple digit.

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“…Warfarin is a commonly used oral anticoagulant for the management of a wide spectrum of cardiac and thromboembolic disorders. Although the most frequently reported adverse effects are haemorrhage‐related, less common cutaneous side‐effects can include skin necrosis, pruritic maculopapular eruption, livedo reticularis, leucocytoclastic vasculitis and ‘purple toes syndrome’ 1,2 . We report an unusual case of unilateral purple toes associated with warfarin therapy, which resolved completely on withdrawal.…”

mentioning

confidence: 92%