Epidemiology and symptomatology of long acting anticoagulant rodenticide poisoning

Abstract

Background: Long acting anticoagulant rodenticides (LAARs) are widely used pesticides that initiate anticoagulation through a vitamin K antagonist (VKA) mechanism. Human exposures produce presentations ranging from asymptomatic to fatal. Methods: A comprehensive literature search and search of relevant databases was conducted. Data related to epidemiology of LAAR exposure as well as clinical manifestations of LAAR poisoning and clinical management were extracted. Results: Between 1987 and 2012, 315,951 total exposures were reported to the American Association of Poison Control Centers. Of these, 95.6% were unintentional and 88.9% occurred in children under the age of six. Moderate or major effects occurred in only 0.6% of human LAAR exposures. Of reviewed case reports, the most common hemorrhagic manifestations were mucocutaneous. Fatalities were most commonly associated with intracranial hemorrhage and intentional misuse. Multiple routes of exposure have been reported including oral, percutaneous, and inhalational. Treatment courses required prolonged administration of high dose vitamin K. Conclusions: Most instances represent unintentional LAAR exposures among children. Although the majority of exposures are asymptomatic, serious coagulopathy may occur, and LAAR poisoning may not immediately be considered as an etiology. A heightened awareness for this entity and awareness of diagnosis and treatment principles are critical to appropriate management.

Treatment of a long-acting anticoagulant rodenticide poisoning cohort with vitamin K1 during the maintenance period

“…[27,28] Further, the dose of vitamin K1 injections should not exceed 40 mg according to the manufacturer's instructions. The above limitations make the rescue of LAAR poisoning patients a national problem.…”

Brodifacoum-Laced Synthetic Marijuana Toxicity: A Fight Against Time

“…A fatal dose for a 60-kg man is 15 mg without treatment. The onset of increased INR can be delayed by up to 48 h after ingestion, so it is very important to monitor patients with brodifacoum ingestion by regularly checking the INR [ 3 , 4 , 8 ].…”

“…Maintenance doses vary depending upon the condition, ranging from 15 mg to 600 mg per day in divided doses. The most common dosage is 100 mg per day (given in divided doses), usually given for 30 to 200 days (the duration of treatment can vary) [ 3 , 4 , 8 ].…”

Pharmacokinetics of Anticoagulant Rodenticides in Target and Non-target Organisms

“…Field et al (1952)), have wide application in human anticoagulation therapy. Human exposure to anticoagulants through rodenticide bait can occur (Tran and King 2015;Watt et al 2005) and is most typically oral, whether accidental (e.g., exploratory ingestion by very young children) or deliberate (e.g., attempts at self-harm) (e.g. Bruno et al 2000).…”