bromfenacoum and Epistaxis

Topics: 4-Hydroxycoumarins; Abdominal Pain; Adult; Ecchymosis; Epistaxis; Female; Hematemesis; Hematoma; Hematuria; Humans; Male; Public Health; Rodenticides; Social Problems

A 50-year-old man was admitted to the emergency department with abrupt massive epistaxis. An accurate anamnesis and physical evaluation could not reveal any other anomalies, while coagulation tests showed potentially life threatening prolonged prothrombin time, with activated partial thromboplastin and thrombin time, with fibrinogen and antithrombin III within limits. Despite the prompt pharmacological and compressive local treatment, bleeding continued and the patient was therefore hospitalized. Highly specific coagulation and toxicological testing-among others high-performance liquid chromatography assessment on plasma-were performed, leading to the unexpected identification of brodifacoum. Police and criminal justice authorities revealed the source of exposure to brodifacoum after several months of investigation, residing in his everyday life. Brodifacoum is a long-lasting anticoagulant, acting as a vitamin K antagonist, and belongs to the family of superwarfarins. Brodifacoum use is authorized as rodenticide in many countries worldwide, but has been reported as cause of severe coagulopathies in humans, both intentional or involuntary, even consumed as a contaminant of herbal drugs, such as cannabis. The original contribution of this case to the knowledges of human brodifacoum intoxication resides in the multidisciplinary approach and the collaborative interplay of clinical and toxicology experts as well as judicial authorities.

Topics: 4-Hydroxycoumarins; Accidents; Anticoagulants; Chromatography, High Pressure Liquid; Epistaxis; Forensic Medicine; Homicide; Humans; Male; Middle Aged; Rodenticides

Topics: 4-Hydroxycoumarins; Anticoagulants; Blood Coagulation; Blood Coagulation Tests; Blood Component Transfusion; Contusions; Epistaxis; Female; Gastrointestinal Hemorrhage; Humans; Middle Aged; Rodenticides; Vitamin K 1

Topics: 4-Hydroxycoumarins; Adult; Anticoagulants; Diagnosis, Differential; Epistaxis; Female; Hematemesis; Humans; Partial Thromboplastin Time; Pesticides; Poisoning; Prothrombin Time; Thrombosis; Unconsciousness; Vitamin K; Vitamin K Deficiency

Topics: 4-Hydroxycoumarins; Adult; Blood Coagulation Disorders; Blood Coagulation Factors; Crack Cocaine; Drug Synergism; Epistaxis; Hemorrhage; Humans; Male; Retroperitoneal Space; Rodenticides

A captive white-winged wood duck (Cairina scutulata) with bilateral epistaxis and anemia (packed cell volume = 16%) was treated with injectable and oral vitamin K1 and transfused with 40 ml whole blood. Brodifacoum was detected in blood at 0.002 ppm. The bird made an uneventful recovery. This report illustrates the risk of anticoagulant pest control products in a zoological setting.

Topics: 4-Hydroxycoumarins; Administration, Oral; Animals; Anticoagulants; Antifibrinolytic Agents; Bird Diseases; Blood Transfusion; Ducks; Epistaxis; Female; Male; Rodenticides; Vitamin K 1