"Purple Toes": an Uncommon Sequela of Oral Coumarin Drug Therapy

Abstract

Article1 December 1961"Purple Toes": an Uncommon Sequela of Oral Coumarin Drug TherapyWALTER FEDER, M.D., ROBERT AUERBACH, M.D.WALTER FEDER, M.D., ROBERT AUERBACH, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-55-6-911 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe utility of coumarin type anticoagulants during the acute stage of many types of thrombo-embolic incidents, including myocardial infarction, has been well established clinically. More recently, the efficacy of these drugs for long-term prophylaxis has also been shown to be of value (1-4), and there is an increasing population of patients on long-term oral anticoagulant therapy. The purpose of this paper is to describe a dermatologic side effect of such therapy, which, to the best of our knowledge, has not been reported previously.Our attention was directed to six patients who developed a dark blue-tinged bilateral purple discoloration of the...References1. BJERKLUND CJ: The Effect of Long-term Treatment with Dicumarol in Myocardial Infarction. Thesis published by Oslo University Press, Oslo, 1957, pp. 1-212. Google Scholar2. BRITISH MEDICAL RESEARCH COUNCIL: An assessment of long-term anticoagulant administration after cardiac infarction. Brit. Med. J. 1: 803, 1959. CrossrefMedlineGoogle Scholar3. MANCHESTER B: The prevention of myocardial infarction. Arch. Intern. Med. 100: 959, 1957. CrossrefGoogle Scholar4. BORCHGREVNIK CF: Long-term anticoagulant therapy in angina pectoris and myocardial infarction. Acta Med. Scand. Vol. 168, Supp. 359, 1960. Google Scholar5. SHEPSGIFFORD SGRW: Urticaria after administration of warfarin sodium. Amer. J. Cardiol. 3: 118, 1959. CrossrefMedlineGoogle Scholar6. ADAMSPASS CWBJ: Extensive dermatitis due to warfarin sodium (Coumadin). Circulation 22: 947, 1960. CrossrefMedlineGoogle Scholar7. VERHAGENWIERSEMA HMW: Cutaneous hemorrhages and necrosis in thrombosis treated with Dicumarol. Ned. T. Geneesk. 96: 482, 1952. MedlineGoogle Scholar8. VERHAGEN H: Local hemorrhage and necrosis of the skin and underlying tissues during anticoagulant therapy with Dicumarol or Dicumacyl. Acta Med. Scand. 148: 453, 1954. CrossrefMedlineGoogle Scholar9. JORDAL R: Necrosing cutaneous hemorrhages as a complication of Dicumarol treatment. Acta Med. Scand. 154: 477, 1956. CrossrefMedlineGoogle Scholar10. MIKELSEN AP: Abortiv haemorrhagisk hudnekrose efter Dicumarol. Nord. Med. 60: 1758, 1958. MedlineGoogle Scholar11. WICKE G: Ortliche Nekrosen nach Behandlung mit Dicumarinen. Ärtzneimittel Wschr. 10: 896, 1955. Google Scholar12. FRIISSORENSENTILFAALDE TKT: Af Dicumarolnekrose. Ugeskr. Laeg. 121: 577, 1959. MedlineGoogle Scholar13. KEYRILAINEN O: Haemorrhagisk hudnekrose efter Phenylindandion. Nord. Med. 59: 567, 1958. MedlineGoogle Scholar14. HAUGE JF: Haemorrhagisk hudnekrose ved. Dicumarolbehandling. Nord. Med. 58: 1266, 1957. MedlineGoogle Scholar15. SCHWARTZ M: Haemorrhagisk hudnekrose ved. Dicumarolbehandling. Nord. Med. 58: 1264, 1957. MedlineGoogle Scholar16. GROTHTENGSTROM OB: Haemorrhagic necrosis of the skin during Dicumarol therapy. Acta Dermatovener. (Stockh.) 40: 104, 1960. MedlineGoogle Scholar17. ALLENBARKERHINES EVNWEA: Peripheral Vascular Disease, 2d Ed., W. B. Saunders Company, Philadelphia, 1955, pp. 104-105. Google Scholar18. KUSCHINSKYLUDEWIG GH: Permeabilitätsänderungen durch Dicumarol von anderungen der prothrombinzeit. Arch. Exp. Path. Pharmakol. 210: 404, 1950. MedlineGoogle Scholar19. LINKE A: Vergleichende Untersuchungen uber die Wirkung von Dicumarol und Tromexan auf dem Prothrombingehalt des Blutes, die Kapillarresistenz, und die Kapillarpermeabilität. Deutsch Med. Wschr. 77: 775, 1952. CrossrefMedlineGoogle Scholar20. MATISHAGER PH: Zur Wirkung des Dicumerols auf die Permeabilität der Kapillaren. Z. Ges. Exp. Med. 118: 131, 1951. CrossrefMedlineGoogle Scholar21. NEUMAYRSCHMID AJ: Kapillarpermeabilität und Antithrombon. Schweiz. Med. Wschr. 78: 616, 1948. MedlineGoogle Scholar22. SCHMIDSTOCKINGER JL: Zellwachstum und Dikumarine. Wien Z. Inn. Med. 32: 67, 1951. MedlineGoogle Scholar23. BRODERSENKJAER RA: The antibacterial action and toxicity of some unsaturated lactones. Acta Pharmacol. (Kbh.) 2: 109, 1946. CrossrefMedlineGoogle Scholar24. PATELPATEL RPMA: Effects of heparin, Treburon, Dicumarol and Tromexan on blood vessels. Indian J. Med. Res. 47: 169, 1959. MedlineGoogle Scholar25. GILBERTNALEFSKI NCLA: Effect of heparin and Dicumarol in increasing the coronary flow volume. J. Lab. Clin. Med. 34: 797, 1949. MedlineGoogle Scholar26. DOUGLAS AS: Mode of action of coumarin drugs. Brit. Med. Bull. 11: 39, 1955. CrossrefMedlineGoogle Scholar27. BACHMANNDUCKERTKOLLER FFF: The Stuart Prower factor and its clinical significance. Thromb. Diath. Haemorrh. 2: 24, 1959. Google Scholar28. HOAKCONNORWARNERCARTER JCWEEDJR: The antithrombotic properties of coumarin drugs. Ann. Intern. Med. 54: 73, 1961. LinkGoogle Scholar29. NAEYE RL: Plasma thromboplastin component: influence of coumarin compounds and vitamin K on its activity in serum. Proc. Soc. Exp. Biol. Med. 89: 81, 1955. MedlineGoogle Scholar30. PEYMAN MA: The significance of hemorrhage during the treatment of patients with the coumarin anticoagulants. Acta Med. Scand. Vol. 162 Supp. 339, 1958. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: WALTER FEDER, M.D.; ROBERT AUERBACH, M.D.From the Department of Medicine, University of Chicago, Chicago, Illinois.Requests for reprints should be addressed to Walter Feder, M.D., Department of Medicine, University of Chicago, 950 East 59th Street, Chicago 37, Illinois. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byUn syndrome des orteils bleus révélant un cancer de la prostate métastatique : une observation avec analyse de la littératureFatal Course of Cutaneous Cholesterol Embolization Syndrome: A Case ReportAntithrombotic and Antiplatelet Drug ToxicityReporte de casos de síndrome de dedo azulBlue finger syndrome: Case reportsCholesterol Crystal Embolism Induced by Direct Factor Xa Inhibitor: A First Case ReportCoumarin anticoagulantsAortic Atherosclerosis as an Embolic SourceTreatment of "Blue toe" syndrome with Hyperbaric oxygen therapy: Case studyWarfarin-induced purple toe syndrome successfully treated with apixabanCholesterol embolization of right colon, misdiagnosed as colon tumorAgents for the Management of Hematologic ReactionsAtheroembolismThe Purple Toe Syndrome in Female With Factor V Leiden Mutation Successfully Treated With EnoxaparinEtiology of 'blue toe' syndrome: Emboli versus warfarin therapy. Report of a caseDrug-induced Nail ChangesLate Onset Purple Toe Syndrome With Warfarin Successfully Treated With FondaparinuxAortic Atheromas: Current Knowledge and Controversies: A Brief Review of the LiteratureSigno del dedo azul como manifestación inicial de aneurisma de la arteria poplíteaBlue Toe Sign as the Initial Manifestation of a Popliteal Artery AneurysmToe-tip purpuraAcrocyanosis: The Flying DutchmanDrug ReactionsAtheroembolic renal disease2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic DiseaseThe Purple DigitLack of Association between Dialysis Modality and Outcomes in Atheroembolic Renal DiseaseANTICOAGULANTS, THROMBOLYTIC AGENTS, AND ANTI-PLATELET DRUGSADVERSE CARDIOVASCULAR EFFECTS OF NON-CARDIOVASCULAR DRUGSEmbolies de cristaux de cholestérolBlue (or purple) toe syndromeSegmental testicular infarction due to cholesterol embolism: Not the first case, but the first reportReferencesREVIEW: Aortic Atheromas: Current Concepts and Controversies-A Review of the LiteratureWat is de oorzaak en behandeling van het blue-toe-syndroom?Coumarin anticoagulantsPurple Toe SyndromeAtheromatous embolizationPigmentation AbnormalitiesSystemic DrugsThe incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective studyCap polyp of the esophagus caused by cholesterol embolizationPurple Toes Syndrome Associated with Warfarin Therapy in a Patient with Antiphospholipid SyndromeCholesterol Crystal Embolization (CCE) after Cardiac CatheterizationFatal warfarin-induced skin necrosis after total hip arthroplastyAdverse Dermatologic Effects of Cardiovascular Drug Therapy: Part IIIAnticoagulant-related skin reactionsCholesterol embolism: an often unrecognized cause of leg ulcersCholesterol embolization syndrome: cutaneous histopathological features and the variable onset of symptoms in patients with different risk factorsAnticoagulation in the Ambulatory Patient: Basic Principles and Current Concepts in Warfarin TherapyClinical Pearls Cold FeetAtheroembolic Renal DiseaseBlue Toe Syndrome: Treatment with Intra-arterial Stents and Review of TherapiesMobile Aortic Atheroma and Systemic Emboli: Efficacy of Anticoagulation and Influence of Plaque Morphology on Recurrent StrokePulmonary Cholesterol Crystal EmbolizationIncidence of Atheroembolic Renal Failure After Coronary AngiographyCHOLESTEROL EMBOLI: A Common Cause of Renal FailureAtheromatous EmbolismAtherosclerotic Disease of the Aortic Arch as a Risk Factor for Recurrent Ischemic Stroke79-Year-Old Woman With Blue ToesAtherosclerotic Disease of the Aortic Arch and the Risk of Ischemic StrokeAtherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients.Duodenoscopic view of cholesterol crystal embolizationCase 38-1993Cholesterol embolism: An underdiagnosed clinical entityCholesterol embolism to the skinThe Prevalence of Ulcerated Plaques in the Aortic Arch in Patients with Stroke"Shaggy" Aorta Syndrome with Atheromatous Embolization to Visceral VesselsAnticoagulants and ThrombolyticsCase report: Cholesterol embolization following angiographyCholesterol embolization: Clinical findings and implicationsCholesterol emboli syndrome following cardiac catheterizationManifestations cérébrales des angéites nécrosantesWarfarin-related purple toes syndrome and cholesterol microembolizationAcral purpura: An unusual sign of coumarin necrosisThe blue toe syndrome: Hemodynamics and therapeutic correlates of outcomeLivedo reticularis due to multiple cholesterol emboliNail Pigmentation AbnormalitiesNail Changes Caused by Systemic Drugs or lngestantsThe "Blue Toe" Syndrome with Renal Atheroembolism and FailureNail changes secondary to systemic drugs or ingestants"Purple toes" syndromePurple Toe SyndromeCUTANEOUS ATHEROMATOUS EMBOLISMPurple Toe SyndromeORAL ANTICOAGULATION IN THE SECONDARY PREVENTION OF MYOCARDIAL INFARCTIONDiabetic foot care"Purple Toes" SyndromeWarfarin-Induced Necrosis of SkinJEROME P. LACY, M.D., ROBERT R. GOODIN, M.D., F.A.C.C.Disseminated intravascular coagulationWarfarin TherapyCase 25-1967Cholesterol Embolization 1 December 1961Volume 55, Issue 6Page: 911-917KeywordsAnticoagulant therapyAnticoagulantsCoumarinsDrug therapyGratitudeHemorrhageLesionsMyocardial infarctionOral medicineProphylaxis ePublished: 1 December 2008 Issue Published: 1 December 1961 PDF downloadLoading ...