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Haemarthrosis after superwarfarin poisoning
Panagiotis Kotsaftis1, Fotios Girtovitis, Afroditi Boutou
11st Department of Propedeutics in Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
European Journal of Haematology
|July 28, 2007
Summary
Superwarfarin poisoning causes severe bleeding and requires prolonged, high-dose vitamin K treatment. This case highlights haemarthrosis as a rare complication of superwarfarin rodenticide ingestion.
Area of Science:
- Toxicology
- Hematology
Background:
- Superwarfarins are potent rodenticides causing prolonged bleeding disorders.
- Poisoning can lead to severe hemorrhage from multiple sites.
Observation:
- A 67-year-old male presented with melaena, epistaxis, and knee haemarthrosis after ingesting rodenticide.
- Initial treatments with blood products failed, with worsening coagulopathy (elevated PT, INR, aPTT).
- Diagnosis of superwarfarin poisoning was confirmed after patient admission of suicide attempt.
Findings:
- Superwarfarin poisoning necessitates prolonged, high-dose vitamin K therapy (30 mg daily for 4 months).
- Haemarthrosis is identified as a novel complication of superwarfarin poisoning.
- Normal mixing studies and liver function tests aided in diagnosing vitamin K-dependent clotting factor deficiency.
Implications:
- This case underscores the severity and prolonged nature of superwarfarin toxicity.
- Highlights the importance of considering superwarfarin poisoning in unexplained coagulopathies.
- Emphasizes the need for extended vitamin K treatment and recognition of rare complications like haemarthrosis.
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