**Core Concept**
Warfarin toxicity leads to an imbalance in vitamin K-dependent clotting factors, primarily affecting proteins C and S, which are anticoagulant proteins. This imbalance results in a hypercoagulable state, increasing the risk of thrombosis.

**Why the Correct Answer is Right**
Warfarin toxicity-related skin necrosis is a rare but serious condition, typically occurring in the subcutaneous fat of the breast, buttocks, thighs, or upper arms. This condition is often associated with the initiation of warfarin therapy, particularly in patients with protein C deficiency. The most common sites for skin necrosis are not toes and tips of fingers, but rather areas with a high concentration of subcutaneous fat. The decreased quantity of protein C due to warfarin toxicity contributes to the development of skin necrosis.

**Why Each Wrong Option is Incorrect**
**Option A:** Skin necrosis indeed occurs during initiation of warfarin therapy, particularly in patients with protein C deficiency. This is a well-documented complication.
**Option C:** Decreased quantity of protein C is a true statement regarding warfarin toxicity. Protein C is a vitamin K-dependent clotting factor that is reduced in the presence of warfarin.
**Option D:** Starting therapy with low molecular weight heparin (LMWH) can decrease the incidence of adverse effects associated with warfarin initiation, including skin necrosis. This is because LMWH can provide some degree of anticoagulation while warfarin takes effect.

**Clinical Pearl / High-Yield Fact**
It's essential to recognize that warfarin toxicity can lead to a hypercoagulable state, increasing the risk of thrombosis. Patients initiating warfarin therapy should be closely monitored for signs of skin necrosis, particularly in areas with a high concentration of subcutaneous fat.

**✓ Correct Answer: B. Most common sites are toes and tips of fingers**