Warfarin can cause purple toe syndrome, a severe adverse reaction that can progress to gangrene and require amputation if the drug is not permanently discontinued.
Clinicians should permanently discontinue warfarin at first suspicion of purple toe syndrome to avert amputation; single case leaves open incidence and generalizability.
A 75-year-old man presented with painful discoloration and ulceration of his toes of both feet. These symptoms appeared approximately 8 weeks after commencing amiodarone and warfarin. No source of emboli was found. His symptoms resolved completely on stopping warfarin but returned after warfarin was recommenced. He developed dry gangrene and requiring amputation of several toes. Warfarin was stopped again and his symptoms improved significantly.
No takes yet. Share an insight, caveat, or question.
Devalia et al. (2005) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: