Superwarfarin poisoning: A significant public health problem

Rauch, Alan E.; Weininger, Richard; Pasquale, Donald; Burkart, Peter; Dunn, Harry G.; Weissman, Charles; Rydzak, Edward

doi:10.1007/bf02260521

Cited by 23 publications

(21 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, absorption through the skin can occur, and a number of cases with an unknown origin have been encountered. [6][7][8][9] Here, we report a case of brodifacoum intoxication with no identified route, which was confirmed by the detection of brodifacoum in serum. …”

Section: Introductionmentioning

confidence: 70%

A Case of Superwarfarin Intoxication without a Definitive History of Brodifacoum Exposure

et al. 2009

View full text Add to dashboard Cite

Superwarfarin intoxications that induce profound and prolonged coagulopathy are being increasingly reported, to such an extent that it is becoming a comparatively common intoxication. However, there have been few reported cases of superwarfarin intoxication with an inadvertent cause or an unknown origin. A 58-year-old man with recurrent painless hematuria was found to have an acquired deficiency of vitamin K dependent clotting factors, and a large amount of vitamin K was required to correct the coagulopathy. He had no history of warfarin use or any exposure to rodenticides, but brodifacoum was detected in his serum. It is important for physicians to be aware that significant coagulopathy can occur secondary to superwarfarin intoxication, without any known exposure to substances that might induce this.

show abstract

Section: Introductionmentioning

confidence: 70%

A Case of Superwarfarin Intoxication without a Definitive History of Brodifacoum Exposure

et al. 2009

View full text Add to dashboard Cite

show abstract

“…The capability of terrorists to use these commercially available poisons depends upon the availability of large amounts of high-concentration product (whether obtained legally or illegally), the target population and its vulnerability, and the method of effective delivery and dissemination (EPA, 2005;WHO, 2008). Although these anticoagulants may be absorbed through the skin and lungs, the main route of exposure is ingesting food or water containing the product (Jones et al, 1984;Katona and Wason, 1989;Swigar et al, 1990;Wallace et al, 1990;Exner et al, 1992;Rauch et al, 1994;Gallo, 1998;Corke, 1997). Superwarfarin poisoning may result in a large number of casualties if these substances are ingested (Palmer et al, 1999;Baker et al, 2002;EPA, 2005;POISINDEX, 2007;HSDB, 2008).…”

Section: Introductionmentioning

confidence: 95%

“…Newer long-acting warfarin derivatives such as brodifacoum, bromadiolone, diphenadione, and chlorophacinone can produce profound and prolonged anticoagulation and bleeding after a latency period that generally lasts 24-72 h FDA, 1985;Chong et al, 1986;Greeff et al, 1987;Smolinske et al, 1989;Swigar et al, 1990;Wallace et al, 1990;Routh et al, 1991;Wilton, 1991;Exner et al, 1992;Rauch et al, 1994;IPCS, 1995a-e;Hui et al, 1996;Tecimer and Yam, 1997;Chua and Friedenberg, 1998;Gallo, 1998;EPA, 2003EPA, , 2005 (Table 18.1).…”

Section: Introductionmentioning

confidence: 97%

“…For example, a bait concentration of only 50 ppm of brodifacoum is adequate to control the population in a single feeding for most rodents and noncommensal species (Matolesy et al, 1988). These newer compounds were called second-generation anticoagulant rodenticides and are often now referred to as superwarfarins in the contemporary medical literature (e.g., Chong et al, 1986;Greeff et al, 1987;Swigar et al, 1990;Wallace et al, 1990;Routh et al, 1991;Wilton, 1991;Exner et al, 1992;Rauch et al, 1994;Hui et al, 1996;Tecimer and Yam, 1997;Gallo, 1998;Chua and Friedenberg, 1998;Pavlu et al, 2005;Sharma and Bentley, 2005;Dolin et al, 2006).…”

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Superwarfarins

Murphy¹,

Lugo²

2015

Handbook of Toxicology of Chemical Warfare Agents

View full text Add to dashboard Cite

“…[3,4] Due to their high-lipid solubility, increased affinity for hepatic enzymes, and significant increase in potency as well as their ability to overcome resistance, LAARs earned the moniker "superwarfarin", which continues in use today. [5][6][7][8] LAARs induce anticoagulation through inhibition of the Vitamin K Epoxide Reductase enzyme. [1] This inhibition leads to reduced ability to gamma-carboxylate terminal glutamine residues of Vitamin K Dependent coagulation factors.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and symptomatology of long acting anticoagulant rodenticide poisoning

Tran

2015

JER

View full text Add to dashboard Cite

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.

show abstract

Superwarfarin poisoning: A significant public health problem

Cited by 23 publications

References 26 publications

A Case of Superwarfarin Intoxication without a Definitive History of Brodifacoum Exposure

A Case of Superwarfarin Intoxication without a Definitive History of Brodifacoum Exposure

Superwarfarins

Epidemiology and symptomatology of long acting anticoagulant rodenticide poisoning

Contact Info

Product

Resources

About