Combined Superwarfarin and Ethylene Glycol Ingestion:<i>A Unique Case Report With Misleading Clinical History</i>

Seidelmann, Sarah; Kubic, Virginia; Burton, Eric; Schmitz, Laura L.

doi:10.1093/ajcp/104.6.663

Cited by 11 publications

(4 citation statements)

References 16 publications

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“…However, use of FFP and plasma products carries the risk of transmission of viral disease, allergic reactions and, in the case of FFP, volume overload [26] and variable content of vitamin K-dependent clotting factors. To avoid all these risks, we decided to reverse the anticoagulant effects of chlorphacinone with a single bolus dose of rFVIIa.…”

Section: Discussionmentioning

confidence: 99%

“…In healthy volunteers receiving acenocoumarol twice daily to maintain an INR higher than 2, both the INR and PT were normalized after administration of a single dose of 5-320 mg/kg body weight rFVIIa [26]. Deveras and Kessler described rFVIIa administration to 13 adults receiving warfarin to treat or prevent primary and secondary venous and arterial thromboembolic complications, and who required rapid reversal of a critically prolonged INR and excessive anticoagulation [30].…”

Section: Discussionmentioning

confidence: 99%

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Successful reversal of anticoagulant effect of superwarfarin poisoning with recombinant activated factor VII

Zupančić-Šalek

Kovačević-Metelko

Radman

2005

Blood Coagulation &Amp; Fibrinolysis

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The use of second-generation anticoagulants termed "superwarfarins" as rodenticides, although widespread, is poorly controlled. Products containing superwarfarin have been marketed in over-the-counter rodenticides and can be easily purchased. Poor control potentiates the risk of accidental or intentional poisoning, but clinicians may underestimate the incidence of superwarfarin toxicity. Therefore, when cases of unexplained acquired coagulopathy and selective deficiency of vitamin K-dependent clotting factors occur in patients in the absence of liver disease or inhibitors, physicians should consider the possibility of superwarfarin poisoning as a cause. According to our own experience, recombinant activated factor VII (NovoSeven; Novo Nordisk, Bagsvaerd, Denmark) appears to be a safe and effective therapy for acute bleeding caused by superwarfarin poisoning. Due to the extended half-life of the second-generation rodenticides, follow-up therapy with oral vitamin K1 should be of long-term duration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successful reversal of anticoagulant effect of superwarfarin poisoning with recombinant activated factor VII

Zupančić-Šalek

Kovačević-Metelko

Radman

2005

Blood Coagulation &Amp; Fibrinolysis

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“…The severity of the intoxication depends on the amount of rodenticide ingested, preexisting comorbidity, and coingestion of other toxic substances (Seidelmann et al, 1995;Palmer et al, 1999;Stanziale et al, 1997;Tecimer and Yam, 1997;Walker and Beach, 2002). Fatalities are usually due to intentional suicidal ingestion of large amounts.…”

Section: Adult Exposuresmentioning

confidence: 99%

Superwarfarins

Murphy¹,

Lugo²

2015

Handbook of Toxicology of Chemical Warfare Agents

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“…A pesar de la similitud en el mecanismo de acción respecto a las warfarinas, el Brodifacum es cinco veces más potente, como anticoagulante, que aquellas [1][2][3][4][5][6][7][8][9][10][11]. La toxicidad del producto depende de diversos factores: a) una vida media bastante larga (24 días, aproximadamente); b) su gran volumen de distribución (seis veces más alto que el de la warfarina); c) un aclaramiento plasmático muy bajo, probablemente porque la droga posee un circuito entero-hepático.…”

Section: Introductionunclassified

Neuropatía hemorrágica tóxica aguda y fallo multiorgánico tras intoxicación por anticoagulantes, disolventes, AINES y antihistamínicos: A propósito de un caso fatal

Garfia¹,

Salguero²,

Martı́nez³

et al. 2002

Cuad. med. forense

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RESUMENSe presenta un caso de intoxicación mortal por ingestión del raticida Brodifacum, un anticoagulante superwarfarínico, junto con otros fármacos, entre los que se incluían antiinflamatorios no esteroideos y un disolvente orgánico de uso doméstico. El sujeto falleció en la UCI, con un cuadro de insuficiencia respiratoria aguda, seguida de fallo hepático y renal. En la autopsia se pusieron de manifiesto lesiones hemorrágicas circunferenciales que afectaban a diversos tejidos, entre los que se encontraban la grasa mesentérica, el epicardio, y la grasa perirrenal. El estudio microscópico demostró la existencia de una típica lesión hemorrágica aguda, circunferencial, en los nervios vegetativos epicárdicos y del área del esplácnico. La explicación de porqué los nervios periféricos vegetativos se constituyen en diana de los efectos tóxicos se atribuye a la acción combinada de los disolventes y de los anticoagulantes, sobre el sistema nervioso periférico. Se sabe que los disolventes orgáni-cos producen una lesión neuronal aguda, consistente en tumefacción axonal y del soma neuronal, que conlleva a la alteración del sistema de transporte a lo largo del axón. Creemos que -desde el punto de vista fisiopatoló-gico-la vasodilatación reactiva de los vasa nervorum, producida a consecuencia de la lesión neuronal aguda inducida por los disolventes, unida al estado de hipocoagulabilidad sanguínea -dependiente de la ingestión de Brodifacum (superwarfarina) y potenciada por los antiinflamatorios no esteroideos-constituyen los mecanismos íntimos que podrían explicar esta peculiar Neuropatía Hemorrágica Aguda Tóxica de los nervios perifé-ricos del Sistema Nervioso Neurovegetativo. Desconocemos si los nervios periféricos mixtos se encontraban afectados por esta lesión, al carecer de muestras para un estudio definitivo. Palabras clave: Brodifacum. Warfarina. Disolventes. AINES. Antihistamínicos. Intoxicación fatal. Neuropatía hemorrágica tóxica. Raticidas. Toxicología forense. Patología. ABSTRACTIn this paper we describe a case of mortal poisoning by ingestion of the rodenticide Brodifacoum, a superwarfarin anticoagulant, together with other drugs, among which were non steroid anti-inflammatory drugs and a domestic organic solvent. The individual died in the Intensive Care Unit, with acute respiratory insufficiency, followed by hepatic and renal failure. At autopsy round haemorrhagic lesions were seen, which affected several tissues, among which were mesenteric fat, the epicardium, and the peri-renal fat. Microscopic study revealed the existence of a typical acute haemorrhagic lesion, located around the epicardial vegetative nerves and those found in the splanchnic beds. The reason why the peripheral vegetative nerves constitute the target of the toxic effects is attributed to the combined action of the solvents together with the superwarfarin drug, on the Peripheral Nervous System. It is known that organic solvents produce an acute neuronal lesion, consisting in tumefaction of the axon and the neuronal soma, which leads to the al...

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Combined Superwarfarin and Ethylene Glycol Ingestion:A Unique Case Report With Misleading Clinical History

Cited by 11 publications

References 16 publications

Successful reversal of anticoagulant effect of superwarfarin poisoning with recombinant activated factor VII

Successful reversal of anticoagulant effect of superwarfarin poisoning with recombinant activated factor VII

Superwarfarins

Neuropatía hemorrágica tóxica aguda y fallo multiorgánico tras intoxicación por anticoagulantes, disolventes, AINES y antihistamínicos: A propósito de un caso fatal

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