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Atheromatous embolization precipitated by oral anticoagulants
A Bols1, A Nevelsteen, R Verhaeghe
1Department of Bleeding and Vascular Disorders, University Hospital Gasthuisberg, Leuven, Belgium.
Summary
Oral anticoagulants may trigger blue toe syndrome from atheromatous embolization in patients with advanced atherosclerosis. Stopping these drugs and addressing the source of emboli can resolve symptoms, though complications like amputation may occur.
Area of Science:
- Vascular Surgery
- Cardiology
- Dermatology
Background:
- Blue toe syndrome, characterized by blue or purple discoloration of the toes, can be a manifestation of atheromatous embolization.
- Oral anticoagulant therapy is sometimes used in patients with atherosclerosis, a condition that predisposes to atheromatous plaque formation.
Observation:
- This report details five patients who developed blue toe syndrome attributed to atheromatous embolization, with symptoms appearing shortly after or worsening with oral anticoagulant initiation.
- All patients exhibited advanced atherosclerosis, with identified sources of emboli including a "shaggy" aorta, pelvic arteries, or a stenotic femoral artery.
Findings:
- Interruption of oral anticoagulants was followed by resolution of embolization symptoms in all patients.
- Four patients underwent successful reconstructive vascular surgery to remove the source of emboli, while one patient's poor condition precluded surgery.
- One patient required toe amputation due to gangrene, and another died postoperatively from multiple organ failure.
Implications:
- The findings suggest a potential link between oral anticoagulants and the precipitation or exacerbation of atheromatous embolization, leading to blue toe syndrome.
- Recognizing this syndrome and considering the role of anticoagulant therapy is crucial for timely diagnosis and management.
- Management involves discontinuing anticoagulants and, where feasible, surgical eradication of the atheromatous source to prevent further embolic events.