bromfenacoum and Hemorrhagic-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

To determine whether routine follow-up coagulation studies are useful in children with accidental exposures to rodenticides containing superwarfarin compounds.. Retrospective review of poison center charts involving pediatric superwarfarin exposures occurring in two 2-year periods.. An American Association of Poison Control Centers-certified regional poison control center with an annual call volume of 55 000 calls per year from a 2-state area with a combined population of 4 million people.. Prothrombin times and/or international normalized ratios and reported clinical signs of excessive anticoagulation after exposure.. Of 542 children in 4 years of data collection, follow-up prothrombin times and/or international normalized ratios measurements did not detect any significant coagulation abnormalities. No child developed bleeding complications. No child required or received antidotal treatment with vitamin K.. Normal preschool-aged children with unintentional acute exposures to superwarfarin rodenticides do not require any routine follow-up laboratory studies and do not require any medical intervention.

Topics: 4-Hydroxycoumarins; Anticoagulants; Child; Hemorrhagic Disorders; Humans; Prothrombin Time; Retrospective Studies; Rodenticides

A 62-year-old man who presented with gross hematuria was found to have a severe and prolonged coagulopathy. The workup involved mixing studies, which suggested an acquired factor deficiency, and specific factor assays, which demonstrated isolated defects in vitamin K-dependent factors. With vitamin K deficiency excluded, and serum warfarin levels undetectable, so-called superwarfarin ingestion was suspected. This diagnosis was subsequently proved by biochemical evidence (an increase in the serum vitamin K epoxide-vitamin K ratio) and compatible history. This case illustrates how a logical workup can lead to a diagnosis of superwarfarin ingestion, even without a history of such an ingestion. New serum assays for specific superwarfarins are also mentioned. This case report should increase clinicians' awareness of long-acting rodenticide ingestions.

Topics: 4-Hydroxycoumarins; Hemorrhagic Disorders; Humans; Male; Middle Aged; Partial Thromboplastin Time; Poisoning; Prothrombin Time; Rodenticides; Time Factors