vitamin-k-1 and Hematuria

Difenacoum is a long-acting superwarfarin-type anticoagulant that exerts its effect through inhibiting vitamin K 2,3-epoxide reductase. Inhibition of this enzyme leads to reduced bioavailability of the metabolically active form of vitamin K resulting in decreased production of vitamin K-dependent proteins including coagulation factors II, VII, IX and X. A 45-year-old woman with psychiatric illness presented with haematuria. Laboratory test results indicated she had been exposed to a vitamin K antagonist which was subsequently identified as difenacoum. She was initially treated with phytomenadione, red cell suspension and octaplex. She was discharged on 30 mg phytomenadione daily but monitoring of vitamin K markers indicated that compliance was poor, and 152 days post-admission she presented with haemoptysis. Difenacoum and other superwarfarin rodenticides are freely available for purchase by the public. Cases such as this continue to raise issues about their availability and regulation.

Topics: 4-Hydroxycoumarins; Blood Coagulation Factors; Drug Overdose; Erythrocyte Transfusion; Female; Hematuria; Hemoptysis; Humans; Medication Adherence; Mental Disorders; Middle Aged; Rodenticides; Vitamin K 1; Vitamin K Epoxide Reductases

Since superwarfarin is popular and readily available in stores, it may cause intoxication or overexposure, which can result in coagulopathy or abnormal bleeding in humans and, thus, is an important public health problem. We report our clinical experience with superwarfarin intoxication. Nine patients, including eight patients who had histories of ingesting superwarfarin, were studied. Of the patients, hematuria occurred in eight. Laboratory tests among the nine patients showed extremely prolonged prothrombin times and activated partial thromboplastin times, which could be corrected to normal by mixing 1:1 with normal pooled plasma; they also had very low functional levels of factor II, VII, IX, X, and proteins C and S, but normal functional levels of factors V, VIII, fibrinogen, and anti-thrombin III. Large doses of vitamin K1 were needed for 3 months or more to treat and correct the coagulopathy among the patients. The majority of the patients presented with gross hematuria, suggesting that hematuria is probably a major clinical manifestation of superwarfarin intoxication. Prolonged use of large doses of vitamin K1 is needed for the treatment of superwarfarin intoxication.

Topics: 4-Hydroxycoumarins; Adult; Aged; Blood Coagulation Tests; Female; Hematuria; Humans; Male; Middle Aged; Rodenticides; Suicide, Attempted; Vitamin K 1; Vitamins; Young Adult

Topics: Aged; Chronic Disease; Cystitis; Cystoscopy; Estrogens, Conjugated (USP); Female; Hematuria; Hemorrhage; Humans; Lymphoma, Non-Hodgkin; Urinary Bladder Neoplasms; Vitamin K 1

Topics: Abdomen, Acute; Barium Sulfate; Blood Pressure; Blood Transfusion; Cerebrovascular Disorders; Duodenum; Female; Hematemesis; Hematuria; Hemoperitoneum; Humans; Intestinal Obstruction; Jejunum; Laparotomy; Male; Melena; Middle Aged; Myocardial Infarction; Prothrombin Time; Radiography; Vitamin K 1; Warfarin

Topics: Aged; Duodenal Obstruction; Hematoma; Hematuria; Hemoperitoneum; Humans; Laparotomy; Male; Prothrombin Time; Vitamin K 1; Warfarin

Topics: Adult; Aged; Child; Child, Preschool; Cystitis; Female; Hematuria; Humans; Male; Middle Aged; Nephritis; Pyelonephritis; Urologic Diseases; Vitamin K 1

Topics: Blood; Blood Coagulation Tests; Dicumarol; Drug Therapy; Female; Hematuria; Humans; Infant, Newborn; Maternal-Fetal Exchange; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Thrombophlebitis; Toxicology; Uterine Hemorrhage; Vitamin K; Vitamin K 1

Topics: Amobarbital; Child; Chloramphenicol; Chlorpromazine; Diphenhydramine; Hematuria; Hemolysis; Hydrocortisone; Hypoprothrombinemias; Mephenesin; Meprobamate; Penicillins; Phenobarbital; Promethazine; Purpura; Purpura, Thrombocytopenic; Sulfamethizole; Sulfathiazoles; Tetanus; Tetanus Toxoid; Toxicology; Tracheotomy; Trimeprazine; Tubocurarine; Vitamin K 1