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Oxaliplatin Induced Digital Ischemia and Necrosis
Kubilay Karabacak1, Murat Kadan1, Erkan Kaya1
1Department of Cardiovascular Surgery, Gulhane Military Academy of Medicine, Etlik, Ankara, Turkey.
Case Reports in Vascular Medicine
|June 12, 2015
Summary
Oxaliplatin, a chemotherapy drug, can cause rare digital ischemia, leading to fingertip pain and cyanosis. Prompt treatment with iloprost trometamol and heparin can effectively manage this adverse event.
Area of Science:
- Oncology
- Vascular Medicine
- Pharmacology
Background:
- Digital ischemia is a rare but serious complication of certain chemotherapy agents.
- Oxaliplatin is a newer generation chemotherapeutic drug used for advanced colon carcinoma.
Purpose of the Study:
- To report a case of digital ischemia secondary to oxaliplatin treatment.
- To discuss the potential mechanisms and management of this adverse drug reaction.
Main Methods:
- A case report of a 62-year-old woman treated with oxaliplatin, 5-fluorouracil, and folinic acid for advanced colon cancer.
- Clinical presentation, physical examination, digital subtraction angiography, and treatment with iloprost trometamol and low-molecule-weight heparin were documented.
Main Results:
- The patient developed severe pain, paresthesia, and acrocyanosis in her fingertips five days after the third oxaliplatin cycle.
- Physical examination revealed hemorrhagic and ulcerative lesions, with absent radial and ulnar pulses.
- Digital subtraction angiography showed significant vascular resistance; treatment resulted in symptomatic relief within five days.
Conclusions:
- Oxaliplatin can induce digital ischemia, a potentially severe vascular toxicity.
- The exact pathogenesis is unclear but may involve endothelial damage, platelet activation, immune complex deposition, or a hypercoagulable state.
- Early recognition and treatment with vasodilators and anticoagulants are crucial for managing oxaliplatin-induced digital ischemia.
