Purple toe syndrome (please help)

[Kamal]

Hello everybody,

My step-father just had a heart valve replacement surgery about 2,5 months ago, and everything went fine. However, since some 4 weeks ago his toes started getting purple color (he was being treated with coumadin by then). He and my mom went to their doctor in Sao Paulo, and until now they don't know what to do. Seems like all kinds of anticoagulants will start this kind of reaction, leaving (at this time) no option at all but discontinue the anticoagulants - which is impossible, since he had his heart valve replaced with a mechanical one - or keeping them - which is also impossible, since the bruises are getting worse. They are already trying heparin, but no results and the bruises are still there.

If someone knows any case like this and how it was treated, please answer. We are already getting desperate.

Thanks in advance,
Kamal Rishi

 

[jeffp]

These things are always problematic to treat. Most times they slowly resolve, but in those cases they don't, the final result is an amputation of the toe. I've only seen a few of these at that severity in 20+ years. I usually recommend using warm (NOT hot) compresses 5-6 times a day at about 20-30 minutes a time and have had good luck with papaverine. Sorry, I wish I had more definitive options for you.

 

[Nancy]

We have a member whose husband did have this condition. It resolved. Hopefully she will see your post and answer it.

Also Al Lodwick who is an expert on anticoagulation checks out this forum frequently. So, I'm sure you will hear from him as well. This weekend is slow as are most weekends, but I'm sure you will get some answers soon.

 

[ALCapshaw2]

Several months ago I bumped my shin into a tree and developed a HUGE hematoma which bled out into my lower leg, ankle, foot, and TOES.

It took 6 WEEKS to fully resolve and there is still a fairly large area of discoloration at the bump site. I was told to elevate my leg (to waist height) as often as possible and to use 'warm compresses' just as Jeff (a foot doctor) mentioned.

I seem to recall reading something about "purple toes" so you may want to do a SEARCH on VR.com and also an internet search using "purple toes" as the keyword(s).

Good luck in your search.

'AL Capshaw'

 

[Guest]

Purple Toes Syndrome usually starts within hours of starting warfarin. However, there have been some reports of a "delayed" reaction brought about by stopping the warfarin for either a procedure or forgetting to take the medication.

There is very little truly known about this condition. One theory is that it is brought about cholesterol on the walls of the arteries breaking off for some reason when the warfarin is started. These go into the small capillaries in the toes and block off blood flow.

Another theory is that it is tied to a Protein C deficiency. This presents a difficult challenge because you cannot test for this until a person has been off warfarin for 4 to 7 days.

Either way, I think that the treatment should be the same. Heparin (or low-molecular weight heparin such as enoxaparin) should be started and the warfarin stopped for about four days to let the warfarin get out of the body. Maybe longer if the toes do not regain their natural color. Then re-start the warfarin at a low dose (1 mg per day) and build the dose up gradually (increasing to 2 mg daily after about 4 days etc until the INR is up to 3.0. When the INR is well into the therapeutic range, then the heparin can be stopped. Alternately, fondaparanux can be used, (this has not been proven but would be worth a try if the person develops a low white blood cell count from heparin) but this affects the INR (heparin does not) so you need to continue it until the warfarin gets the INR above 4.0.

I have successfully treated one person with skin necrosis and one with purple toes in this manner. They are relatively rare conditions (I have seen over 30, 000 patient visits and there have been only two of these.) They can be fatal however.

When the doctor referred the purple toes patient to me, he told me that his hope was that I could stabilize his INR until he regained some strength and could survive the surgery to amputate his toes. I had the man come in every week from his home 50 miles away and high in the mountains. Over about 4 or 5 months, his toes cleared up and only the tip of the middle toe died and it fell off with no further complications. He avoided all surgery.

Also if the warfarin must ever be stopped, there will need to be heparin bridge therapy and the same process repeated again when he goes back on warfarin.

Best of luck.

 

[Mb]

Hello!

I think Nancy was referring to my husband.

Last summer he had "purple toe" syndrome. This was after being on coumaden for three years. Happened kinda out of the blue. I understand that most of the time, this happens when a person initially goes on coumaden, and it is rare. With my husband, he had been on the drug for over three years.

All of his toes, both feet, turned kind of blue, with small "spots" in some areas. He stayed on the coumaden (and aspirin), and it resolved over a period of 6-8 weeks. He did not loose any of his toes.

I still think (and perhaps I am wrong) that it resulted from his getting VERY upset one day. About 3-4 days later, he started noticing his toes turning color, and they were "sensitive". Went to a couple of Dr.,s - We were told that it was from microemboli breaking off from somewhere (most likely one of his prosthetic valves). He also is in chronic a-fib, so he is at an elevated risk of clotting. - I recall just feeling relieved that they went to his toes, and not his kidney's or somewhere where it could have been a really bad problem.

Good luck - Marybeth

 

[Debrinha GT]

Sou de Curitiba!

Sou de Curitiba!

Oi Kamal, meu nome é Débora e também moro no Paraná, só que em Curitiba. Já respondi o outro thread que tua mãe começou, mas como disse para ela, não posso opinar quanto ao problema pois não estou por dentro do assunto. No entanto, achei que seria interessante me apresentar e dizer que esse site é maravilhoso e muitas das pessoas aqui acabam se tornando amigas. Eu mesma já fiz amizade com muitos membros e obtive informações valiosas sobre o meu problema, e tenho certeza de que vocês também encontrarão muitas repostas para que possam discutir com os médicos encarregados do caso do teu padrasto. Ficarei torcendo e vou colocar tua família na minha lista de orações.
Débora