Clinical analysis of 26 children with long-acting anticoagulant rodenticides (superwarfarin) poisoning

The long-acting anticoagulant rodenticide can inhibit vitamin K epoxide reductase, resulting in coagulation dysfunction and even mortality." as Abstract 1st paragraph.

To explore the clinical characteristics, diagnosis, and clinical management of long-acting anticoagulant rodenticide poisoning in children.

We conducted a retrospective study of 26 children with long-acting anticoagulant rodenticide poisoning.

We included 26 patients (14 boys and 12 girls) with a mean age of 6.40 years. The median incubation period for poisoning was 6 days (range, 2-63). The 26 patients presented with bleeding, including ecchymosis (n = 21), epistaxis (n = 9), gastrointestinal bleeding (n = 9; 6 hematochezia and 3 hematemesis), hematuria (n = 7), gum bleeding (n = 5), bleeding from minor wounds (n = 2), lip and tongue bleeding (n = 2), hematomas of the cheek (n = 2), vaginal bleeding (n = 2), intra-abdominal hemorrhage (n = 2), and intracranial hemorrhage (n = 2). All patients exhibited a significantly prolonged prothrombin time, increased international normalized ratio, prolonged activated partial thromboplastin time, decreased vitamin K-dependent coagulation factor activity, and were plasma anticoagulant rodenticide-positive. Clinical management included initial hemostatic treatment with vitamin K₁ (N = 26) and/or combined with blood component therapy (n = 19), and maintenance therapy with oral vitamin K₁. The treatment course lasted more than 1 month (mean ± SD, 2.82 ± 1.85 months) and up to 10 months. After follow-up, all patients recovered without recurrence of bleeding, with a median time for coagulation function to return to normal of 3.4 months (range, 1.3-10.5). No deaths were observed.

Long-acting anticoagulant rodenticides have a long incubation period and a long-lasting toxic effect. Patients presented with bleeding and coagulation dysfunction and were initially treated with vitamin K₁; maintenance therapy with oral vitamin K₁ can prevent recurrence.