Superwarfarin poisoning

Pavlů, Jiří; Harrington, Dominic J.; Voong, Kieran; Savidge, Geoff F; Jan-Mohamed, Riaz; Kaczmarski, Richard

doi:10.1016/s0140-6736(05)17916-1

Cited by 24 publications

(18 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Most ingestions are accidental, and many patients are children. However, attempted suicide, ingestion associated with psychiatric disorders, and deliberate self-poisoning with denial (Munchausen syndrome), have been reported [7,8,9]. Superwarfarin intoxication via the oral route is well known, but it remains unclear how warfarin enters the sera of patients without any history of oral ingestion.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of risk factors in patients with vitamin K-dependent coagulopathy presumed to be caused by exposure to brodifacoum

Lee

You

Moon

et al. 2014

Korean J Intern Med

View full text Add to dashboard Cite

Background/AimsRecently, many cases of vitamin K-dependent coagulopathy of unknown origin have been reported. Such patients lack any relevant family history and have no systemic disease, raising suspicion of superwarfarin intoxication. We evaluated individual risk factors causing coagulopathy and hemorrhagic symptoms in patients with suspected superwarfarin intoxication. In addition, we determined how to effectively treat vitamin K-dependent coagulopathy caused by suspected superwarfarin intoxication.MethodsSeven patients with suspected superwarfarin intoxication who lacked any definitive history of rodenticide ingestion were included. Thirty-one patients initially diagnosed with rodenticide poisoning were also included. We performed a retrospective chart review of all subjects and examined clinical data including patient demographics and medical histories.ResultsPatients initially diagnosed with rodenticide poisoning were divided into two groups, one of which had a laboratory abnormality (prothrombin time [PT] > 13 seconds) and another group with PTs in the normal range. There was no significant difference between the two groups in any of age, gender, the extent of chronic alcohol consumption, the causative rodenticide, psychiatric problems, ingestion of drugs interacting with warfarin, the extent of intoxication, or the type of ingestion attempt. The albumin level of the former group was significantly lower than that of the latter group (p = 0.014). Furthermore, a significant difference between the two groups was evident in terms of simultaneous ingestion of rodenticide and alcohol (p = 0.023).ConclusionsMost patients with superwarfarin poisoning did not exhibit any complication. When such complications were evident, they were associated with serum albumin level and coingestion of rodenticide and alcohol.

show abstract

Section: Discussionmentioning

confidence: 99%

Evaluation of risk factors in patients with vitamin K-dependent coagulopathy presumed to be caused by exposure to brodifacoum

Lee

You

Moon

et al. 2014

Korean J Intern Med

View full text Add to dashboard Cite

show abstract

“…They exert their anticoagulant effect by inhibiting the conversion of vitamin K 2,3-epoxide to vitamin K hydroquinone, the cofactor required by r-glutamyl carboxylase for the post-translational modification of coagulation factors II, VII, IX, X, protein C, and protein S [8], thereby causing reduced functional activities and antigenic levels of these vitamin K-dependent coagulation Ag antigen, Act functional activity, PT prothrombin time, APTT activated partial thromboplastin time FII:C factor II coagulant activity, FVII:C factor VII coagulant activity, FIX:C factor IX coagulant activity, FX:C factor X coagulant activity, FVII:Ag factor VII antigen, FIX:Ag factor IX antigen, NA not available factors and proteins. The anticoagulant effect may persist for several days to months due to its long half-life and lipophilic nature, even long after superwarfarin cannot be detected in the blood [9].…”

Section: Discussionmentioning

confidence: 99%

“…Superwarfarin intoxication should be suspected when there is a severe deficiency of vitamin K-dependent clotting factors of unknown etiology, with a transient, or no response to standard doses of vitamin K [8]. In addition to these findings, clinical evidence of superwarfarin ingestion or exposure, or testing positive for superwarfarins in the blood make a definitive diagnosis of superwarfarin intoxication.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Superwarfarin intoxication: hematuria is a major clinical manifestation

Chang

Chung

et al. 2009

Int J Hematol

View full text Add to dashboard Cite

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.

show abstract

“…Two patients were treated with long-term IV vitamin K 1 , with one receiving 100 mg IV daily by continuous infusion. The median duration of treatment was 140 days (mean, 168 days; range, 28-730 days) [2,3,[6][7][8]17,50,51,53,[57][58][59][60][61][62][63][64][65][68][69][70]73,74,[77][78][79]. In 2 cases reported in Australia, patients had to be titrated up to a total of 100 mg daily to maintain normal PT levels [6].…”

Section: Treatment Of Laar Poisoningmentioning

confidence: 99%