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Area of Science:

  • Toxicology
  • Pharmacology
  • Hematology

Background:

  • Difenacoum is a long-acting anticoagulant inhibiting vitamin K 2,3-epoxide reductase.
  • This inhibition reduces vitamin K-dependent coagulation factors (II, VII, IX, X).

Observation:

  • A 45-year-old woman with psychiatric illness presented with hematuria.
  • Vitamin K antagonist exposure was confirmed as difenacoum.
  • Initial treatment included phytomenadione, red cell suspension, and octaplex.

Findings:

  • The patient was discharged on daily phytomenadione but showed poor compliance.
  • 152 days post-admission, she presented with hemoptysis, indicating re-exposure.
  • Laboratory monitoring confirmed inadequate vitamin K marker levels.

Implications:

  • Difenacoum and similar superwarfarin rodenticides are readily available to the public.
  • This case underscores concerns regarding the accessibility and regulation of these potent anticoagulants.
  • Further evaluation of public access to difenacoum is warranted to prevent accidental or intentional poisonings.