thromboplastin and Vitamin-K-Deficiency

Superwarfarins are anticoagulant rodenticides similar to warfarin, but which have various substituted phenyl groups replacing the terminal methyl group, resulting in a fat-soluble, long-acting anticoagulant that is nearly 100 times more potent than the parent compound. Since their development, many accidental and intentional cases of consumption have been reported. We describe two cases of consumption, one related to unknown etiology, and the other related to utilization of the superwarfarin to potentiate a drug of abuse. The clinical manifestations including bleeding symptoms and abnormal coagulation assays are discussed. The differential diagnosis is quite broad, and includes all causes of vitamin K deficiency, factor deficiency or inhibitor, disseminated intravascular coagulation (DIC), and liver disease. Differentiating superwarfarin ingestion from the other causes can be quite difficult, but extremely important, as management requires prolonged administration of vitamin K. Other treatment options are discussed as well including, fresh frozen plasma (FFP), and recombinant factor VIIa. Finally, the significance of "lacing" drugs of abuse with superwarfarin to potentiate their effect is discussed, as well as the complications that could develop from such a habit.

Topics: 4-Hydroxycoumarins; Adult; Blood Coagulation Disorders; Diagnosis, Differential; Humans; Male; Middle Aged; Pain; Platelet Count; Prothrombin Time; Thromboplastin; Time Factors; Vitamin K Deficiency

Factor VII appears to be the key regulatory protein in the initiation of both the intrinsic and extrinsic systems of coagulation. The single chain, or zymogen form, of factor VII possesses enzymatic activity which makes it an ideal candidate for the initiation of coagulation following vascular injury. A number of interactions between the intrinsic and extrinsic systems of coagulation have been identified. It appears that factor VII is capable of directly activating factor IX and vice versa. The study of factor VII variants with associated thromboembolic complications may provide a number of answers regarding the initiation and regulation of the blood coagulation process.

Topics: Blood Coagulation; Blood Coagulation Tests; Cerebral Hemorrhage; Enzyme Activation; Factor IX; Factor VII; Factor VII Deficiency; Hemarthrosis; Hemophilia A; Humans; Lipoproteins; Liver Diseases; Neutralization Tests; Partial Thromboplastin Time; Radioimmunoassay; Thromboplastin; Thrombosis; Vitamin K Deficiency

Topics: Female; Humans; Hypoprothrombinemias; Infant, Newborn; Male; Methods; Middle Aged; Prothrombin; Prothrombin Time; Thromboplastin; Vitamin K Deficiency

Topics: Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Calcium; Factor IX; Factor V; Factor VIII; Factor X; Factor XII; Fibrin; Fibrinogen; Humans; Liver Diseases; Phospholipids; Prothrombin; Prothrombin Time; Thromboplastin; Vitamin K Deficiency

Vitamin K deficiency, either dietary or pharmacologically induced by warfarin, was unable to affect the metastatic capacity of cells from a benzopyrene-induced fibrosarcoma in C57BL/6J mice. The same cells had a procoagulant activity, of tissue thromboplastin type, which was also completely unaffected by vitamin K antagonism or deficiency. In another murine model of spontaneous metastasis we previously suggested that depression of a particular procoagulant such as a direct factor X activator might contribute to the antimetastatic activity of warfarin. The failure of vitamin K deficiency to affect both the procoagulant and the metastatic capacity of the model reported here offers strong negative support to the same concept.

Topics: Animals; Fibrosarcoma; Male; Mice; Mice, Inbred C57BL; Neoplasm Metastasis; Thromboplastin; Vitamin K Deficiency; Warfarin

Topics: Blood Coagulation Disorders; Blood Coagulation Tests; Factor VII Deficiency; Hemophilia A; Humans; Prothrombin Time; Thrombocytopenia; Thromboplastin; Vitamin K Deficiency

Topics: Biopsy, Needle; Blood Coagulation Disorders; Hemorrhagic Disorders; Hepatitis; Humans; Hypoprothrombinemias; Infant; Infusions, Parenteral; Iron; Liver Function Tests; Malabsorption Syndromes; Male; Prothrombin Time; Thromboplastin; Vitamin K; Vitamin K Deficiency

Topics: Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Blood Proteins; Coumarins; Factor IX; Humans; Thromboplastin; Vitamin K Deficiency

Topics: Anti-Bacterial Agents; Blood Coagulation Tests; Diagnosis, Differential; Disseminated Intravascular Coagulation; Factor V; Factor VIII; Fibrinogen; Heparin; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Parenteral Nutrition; Prothrombin Time; Thromboplastin; Vitamin K; Vitamin K Deficiency; Vitamin K Deficiency Bleeding

Topics: Blood Coagulation Tests; Blood Platelets; Disseminated Intravascular Coagulation; Factor V Deficiency; Factor VIII; Fibrinogen; Heparin; Humans; Liver Diseases; Prothrombin Time; Thromboplastin; Vitamin K; Vitamin K Deficiency

Topics: Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Blood Coagulation Factors; Blood Platelet Disorders; Blood Platelets; Dicumarol; Factor VII; Glycine max; Hemorrhage; Hemostatics; Humans; Pedigree; Phospholipids; Plasma; Prothrombin; Prothrombin Time; Rabbits; Thrombocytopenia; Thromboplastin; Vitamin K; Vitamin K Deficiency

Topics: Acetone; Animals; Brain Chemistry; Chickens; Methods; Phosphorus; Poultry Diseases; Proteins; Prothrombin Time; Sodium Chloride; Thromboplastin; Tissue Extracts; Vitamin K Deficiency

Topics: Anticoagulants; Blood Coagulation; Blood Coagulation Tests; Factor X; Humans; Proteins; Thromboplastin; Vitamin K Deficiency

Topics: Animals; Blood Coagulation Tests; In Vitro Techniques; Poultry; Sulfonamides; Thromboplastin; Vitamin K Deficiency

Topics: Blood Coagulation Tests; Calcium; Factor VII; Factor VII Deficiency; Humans; Prothrombin; Thrombin; Thromboplastin; Vitamin K Deficiency