bromfenacoum and Factitious-Disorders

For the attention of psychiatric consultants, brodifacoum, a new longer-acting, warfarin-like oral anticoagulant rodenticide, has been used for suicide attempts. The overdose potential with brodifacoum is serious since it is readily available without prescription, and bleeding complications last for weeks to months after a single ingestion. This article reports a case of ingestion and reviews four similar cases from medical literature. Also reviewed are details about mechanism of action, procedures for diagnosis, and treatment requirements. Also, characteristics of persons who ingest long-acting anticoagulants appear to differ from those who ingest short-acting anticoagulants reported from earlier literature.

Topics: 4-Hydroxycoumarins; Anticoagulants; Factitious Disorders; Hemorrhagic Disorders; Humans; Male; Middle Aged; Rodenticides; Suicide, Attempted; Vitamin K

Physicians must have a high index of suspicion when patients have unexplained prolongation of the prothrombin time and bleeding in the absence of detectable warfarin. Several common rodenticides contain modified versions of warfarin that are not detectable in standard warfarin assays. We present a case of surreptitious brodifacoum ingestion in a patient who had years of unexplained bleeding and negative warfarin levels.

Topics: 4-Hydroxycoumarins; Anticoagulants; Factitious Disorders; Female; Hemorrhage; Humans; Middle Aged; Poisoning; Rodenticides

A 27-year-old woman with severe vitamin K deficiency presented with hemoptysis and diffuse pulmonary infiltrates. She rapidly developed respiratory failure requiring ventilatory support. Surreptitious ingestion of brodifacoum, a long-acting warfarin derivative, was ultimately found to be the cause of her coagulopathy and DAH.

Topics: 4-Hydroxycoumarins; Adult; Factitious Disorders; Female; Hemorrhage; Humans; Lung Diseases; Poisoning; Rodenticides

Topics: 4-Hydroxycoumarins; Adult; Drug Overdose; Factitious Disorders; Female; Humans; Prothrombin Time; Vitamin K 1