warfarin and Blue-Toe-Syndrome

Antiphospholipid syndrome is a diagnosis with the clinical manifestations of thromboses in the presence of an antiphospholipid antibody. A 25-year-old man with a history of deep venous thrombosis, pulmonary emboli, and myocardial infarction, and receiving long-term anticoagulation with warfarin, all due to primary antiphospholipid syndrome, presented with blue toe syndrome from a primary superficial femoral artery thrombus. He was anticoagulated with fondaparinux in addition to dipyridamole and aspirin perioperatively. The area of thrombus was resected and reconstructed using a cephalic vein interposition graft. This report reviews antiphospholipid syndrome and identifies potential questions and problems relating to a rare clinical presentation.

Topics: Adult; Antiphospholipid Syndrome; Arterial Occlusive Diseases; Blue Toe Syndrome; Femoral Artery; Follow-Up Studies; Humans; Male; Plastic Surgery Procedures; Radiography; Risk Assessment; Severity of Illness Index; Thrombectomy; Thrombosis; Treatment Outcome; Warfarin

Topics: Anticoagulants; Blue Toe Syndrome; Cholesterol; Embolism, Cholesterol; Humans; Warfarin

Antiphospholipid syndrome is an autoimmune disease characterized by vascular thrombosis involving both the arterial and venous systems that can lead to tissue ischemia or end-organ damage. Much of the literature describes various symptoms at initial presentation, but isolated tissue ischemia manifesting as a solitary blue toe is unusual. We discuss a case of a 23-year-old man who presented to the emergency department with a solitary blue fourth digit with minimal erythema and edema, who was suffering from exquisite pain. Following an extensive workup, the patient was diagnosed with antiphospholipid syndrome with thrombi of the vasculature in their lower extremity. With therapeutic anticoagulation, the patient's symptoms subsided and amputation of the digit was prevented.

Topics: Antibodies, Antiphospholipid; Anticoagulants; Antiphospholipid Syndrome; Blue Toe Syndrome; Computed Tomography Angiography; Diagnosis, Differential; Enoxaparin; Foot; Humans; Male; Pain; Tibial Arteries; Toes; Warfarin; Young Adult

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.

Topics: Anticoagulants; Blue Toe Syndrome; Humans; Male; Middle Aged; Warfarin

Topics: Blue Toe Syndrome; Catheterization, Central Venous; Colonic Neoplasms; Embolism, Cholesterol; Female; Humans; Middle Aged; Pulmonary Embolism; Thrombosis; Warfarin

Topics: Aorta, Thoracic; Aortic Diseases; Arteriosclerosis; Blue Toe Syndrome; Cohort Studies; Embolism, Cholesterol; Heparin; Humans; Ischemic Attack, Transient; Warfarin