Warfarin-related purple toes syndrome and cholesterol microembolization

Atheroembolic Renal Disease and Anticoagulants use: A Case Report and Literature Review

“…It usually follows a triggering event, like invasive vascular procedure, but association with anticoagulants and thrombolytics has been described. It is hypothesized that warfarin may dissolve the fibrin clot or impair the fibrin thrombus formation over the ulcerated atherosclerotic plaque, leading to destabilization of the atheroma and subsequent embolization [6,7].…”

“…It can cause renal impairment by different mechanisms including atheroembolism, glomerular hemorrhage, tubular obstruction by RBC casts, and acute interstitial nephritis. Warfarin was originally reported to cause purple toe syndrome by cholesterol embolization [7], and by the same mechanism it may cause AERD. We present a case of severe renal failure requiring dialysis from warfarininduced atheroembolism.…”

Skin Biopsy as Alternative for Renal Biopsy in Acute Renal Failure and Suspected Cholesterol Emboli Syndrome

“…The cholesterol emboli syndrome primarily affects patients above 60 years of age with two or more risk factors for atherosclerosis. (1,2) The incidence of the syndrome in the general population, is low. For example, in the Dutch population, an average rate of 6.2 cases per million people per year has been reported.…”

“…(6) The cholesterol emboli syndrome is associated with a very high mortality rate (up to 80%). (1,2) The prognosis depends on the degree of organ damage and severity of the underlying vascular condition. Treatment with aspirin appears to have a beneficial effect and in patients suffering from aortal atherosclerosis regression of the atherosclerotic plaque size was observed upon treatment with statins.…”

Utilização de prostaglandina sintética no tratamento da embolia sistêmica de cristais de colesterol, após tratamento endovascular de aneurisma da aorta abdominal

“…First, it should be noted that anticoagulants and thrombolytic drugs are described as factors that cause cholesterol microembolism. In addition, many authors have documented worsened clinical status after the introduction of heparin, as well as the absence of good results with the use of antiplatelet drugs in cases with atheroembolism 8,[16][17][18] ; • the use of vasodilators, especially calcium channel blockers, relieves the ischemic pain of lower limbs secondary to vasospasm. However, the use of angiotensin-converting enzyme inhibitors should be avoided due to their negative effects on kidney function 19 ; • the use of high doses of statins is defended by several authors, as they stabilize the cholesterol-rich atheroma plates, causing improved kidney function and ischemia of lower limbs, due to their anti-inflammatory and immunomodulator properties 20 ; • prostaglandin E 1 (PGE 1 ) is a substance of high biological activity and different properties, such as: vasodilating action, inhibition of platelet aggregation, fibrinolysis activation, modulation of cell proliferation, fibrinogenesis and hemorheological activity 13 .…”