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Why does warfarin cause purple toe syndrome?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on May 21, 2023.

Official answer

by Drugs.com

Purple toe syndrome is thought to be due to small emboli (blood clots) in the blood vessels which cause a bluish-purple color in the toes and feet. It is a fairly rare complication associated with early warfarin use, usually occurring within the first 3 to 8 weeks of treatment.

These clots may block normal blood flow, which could lead to tissue death or the need for amputation of the affected body part.

Other symptoms may include:

  • a cold feeling in the feet
  • pain, swelling
  • possible sloughing off of the skin (necrosis)
  • hot or cold feeling
  • skin changes
  • foot ulcer
  • sudden and severe leg or foot pain
  • purple fingers
  • discoloration anywhere on your body

Check with your doctor immediately if any of these symptoms appear.

Typically, if you are diagnosed with purple toe syndrome, the warfarin therapy is stopped and your healthcare provider may substitute another type of anticoagulant. DO NOT stop warfarin treatment unless directed to do so by a healthcare provider.

This is not all the information you need to know about warfarin for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.

References
  • Pourdeyhimi N, Bullard Z. Warfarin-induced skin necrosis. Hosp Pharm. 2014 Dec;49(11):1044-8. doi: 10.1310/hpj4911-1044. PMID: 25673894; PMCID: PMC4319805.
  • Warfarin. Monograph. Drugs.com. Accessed May 21, 2023 at https://www.drugs.com/warfarin.html

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