By Gary M. White, MD

A purple toe or toes may develop soon after initiation of coumadin therapy. Men are more commonly affected and onset is typically 3-8 weeks after starting or restarting coumadin. Livedo reticularis may be associated and there is evidence that microembolization of cholesterol crystals is the cause. The prothrombin time is usually therapeutic. This syndrome is different from coumadin necrosis but falls under the category of cholesterol emboli.


The toes are frequently but not always tender or painful.




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