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Surreptitious superwarfarin ingestion with brodifacoum
R G Berry1, J A Morrison, J W Watts
1Columbus County Hospital, Whiteville, NC, USA.
Southern Medical Journal
|February 1, 2000
Summary
Physicians should suspect uncommon causes of bleeding, like rodenticide ingestion, when standard tests are negative. Brodifacoum, a warfarin-like rodenticide, can cause prolonged bleeding without detectable warfarin levels.
Area of Science:
- Toxicology
- Hematology
Background:
- Unexplained bleeding and prolonged prothrombin time (PT) in patients warrant thorough investigation.
- Standard warfarin assays may not detect anticoagulant rodenticides.
Observation:
- A patient presented with a history of unexplained bleeding and elevated PT.
- Warfarin levels were consistently undetectable.
Findings:
- The patient's symptoms were attributed to surreptitious ingestion of brodifacoum, a potent anticoagulant rodenticide.
- Brodifacoum is a modified warfarin derivative not detected by standard warfarin assays.
Implications:
- Clinicians must consider non-standard anticoagulant exposures in cases of unexplained bleeding.
- Diagnostic assays for anticoagulant rodenticides should be considered in specific clinical scenarios.