A retrospective analysis of 88 anticoagulant rodenticide poisoning cases: Characteristics and forensic implications

This study aimed to synthesize and analyze toxicological characteristics from reported cases of human anticoagulant rodenticide poisoning, providing reference data for clinical diagnosis and forensic practices. We systematically identified English-language case reports (published since 2000) of human anticoagulant rodenticide poisoning via PubMed and Web of Science. A retrospective analysis was performed on various characteristics, including year, age, gender, manner of poisoning, latency period, clinical symptoms and examination results, primary treatment methods, pathological changes in fatal cases, types and concentrations of rodenticides, and toxicological analysis methods. A total of 88 poisoning cases were identified, comprising 52 cases of accidental poisoning, 31 cases of suicidal poisoning, 3 cases of unknown poisoning and 2 cases of homicide. The median latency period was 4 days (range: 1 ∼ 30). Multi-organ hemorrhage was the predominant clinical manifestation, with hematuria being the most frequently reported symptom (n = 39). Coagulation function tests revealed average values of aPTT, PT, and INR of aPTT: 110 (3.71 ∼ 212) s, PT: 100 (11.6 ∼ 300) s and INR: 9 (0.98 ∼ 38.2), respectively, all significantly exceeding normal ranges. Vitamin K₁ administration (intravenous or oral) was the primary treatment. Six fatalities occurred and autopsy findings in three cases primarily indicated multi-organ hemorrhage and necrosis. About the types of rodenticides, a total of 38 cases reported 7 distinct types, with brodifacoum and bromadiolone being the most common, presenting median concentrations of 0.15 μg/mL (0.05 ∼ 10) and 0.1215 μg/mL (0.00032 ∼ 1.665), respectively, which may be significant for clinical diagnosis and forensic identification. In Conclusion, this retrospective analysis characterized key features of 88 cases of anticoagulant rodenticide poisoning and may provide valuable reference to support clinical management and forensic investigation in suspected poisoning events.