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

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.

• Authors: Hee-Jeong Lee, Mi-Ra You, Woo-Ram Moon, Hyoung Sul, Choon-Hae Chung, Chi-Young Park, Sang-Gon Park
• Journal: The Korean journal of internal medicine (Korean J Intern Med) Vol. 29 Issue 4 Pg. 498-508 (Jul 2014) ISSN: 2005-6648 [Electronic] Korea (South)
• PMID: 25045298 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• 4-Hydroxycoumarins
• ALB protein, human
• Anticoagulants
• Rodenticides
• Serum Albumin
• Vitamin K
• bromfenacoum
• Serum Albumin, Human

Topics

• 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)
• Serum Albumin, Human
• Vitamin K (blood)
• Vitamin K Deficiency Bleeding (blood, chemically induced, diagnosis, therapy)
• Young Adult