Korean J Intern Med.  2014 Jul;29(4):498-508.

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

• Lee HJ
• You MR
• Moon WR
• Sul H
• Chung CH
• Park CY
• Park SG

Abstract

BACKGROUND/AIMS
Recently, 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.
METHODS
Seven 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.
RESULTS
Patients 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).
CONCLUSIONS
Most 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.

Keyword

Vitamin K deficiency bleeding; Brodifacoum; Poisoning

MeSH Terms

4-Hydroxycoumarins/*poisoning
Adolescent
Adult
Aged
Aged, 80 and over
Alcohol Drinking/adverse effects/blood
Anticoagulants/*poisoning
Blood Coagulation/*drug effects
Child
Child, Preschool
Female
Humans
Male
Middle Aged
Partial Thromboplastin Time
Prothrombin Time
Republic of Korea
Retrospective Studies
Risk Factors
Rodenticides/*poisoning
Serum Albumin/metabolism
Vitamin K/*blood
Vitamin K Deficiency Bleeding/blood/*chemically induced/diagnosis/therapy
Young Adult
4-Hydroxycoumarins
Anticoagulants
Rodenticides
Serum Albumin
Vitamin K