Purple toes syndrome

Nonhemorrhagic adverse effects include the rare purple toe syndrome and skin necrosis. 

Sallah S, Thomas DP, Roberts HR. Warfarin and heparin-induced skin necrosis and the purple toe syndrome infrequent complications of anticoagulant treatment. Thromb Haemost 1997 78(2) 785-90. 

Nonhemorrhagic adverse effects associated with warfarin are uncommon but can be serious when they do occur. The purple toe syndrome, manifested as a purphsh discoloration of the toes, is an extremely rare event reported in a small percentage of patients receiving warfarin. The etiology of this unusual phenomenon is unknown, but... 

Toxicity Bleeding, osteoporosis, heparin-induced thrombocytopenia (HIT), hypersensitivity Bleeding, skin necrosis (if low protein C), purple toe syndrome, drug interactions, teratogenic (bone dysmorpho-genesis)... 

A reversible, sometimes painful, bluish discoloration of the plantar surfaces and sides of the toes that blanches with pressure and fades with elevation (purple toe syndrome) may develop 3-8 weeks after initiation of therapy with warfarin cholesterol emboli released from atheromatous plaques have been implicated as the cause. Infrequent reactions include alopecia, urticaria, dermatitis, fever, nausea, diarrhea, abdominal cramps, and anorexia. 

Coumarin-induced allergic reactions such as Quincke s oedema and urticaria, though very rare, are known (26 ). Another case report of the so-called purple toes syndrome ascribed to toxicity of oral anticoagulants is not convincing 16 ). 

DiCato, M. A. (1975) Purple toes syndrome. An uncommon complication of oral anticoagulant therapy. Postgrad. Med., 58, 133. 

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