Aortic dissection precipitated by superwarfarin (brodifacoum) poisoning: a case report and pathophysiological review

Poisoning by rodenticides, particularly anticoagulant agents, has been well-documented. Brodifacoum, a second-generation "superwarfarin", is a long-acting anticoagulant rodenticide (LAAR) characterized by an extended half-life. Its toxicity primarily manifests as excessive or abnormal bleeding from the skin, mucous membranes, gastrointestinal tract, and urinary tract. However, aortic dissection (AD)-a rare and catastrophic medical event-has seldom been reported as a complication of such poisoning. We present a case of extensive aortic dissection triggered by Brodifacoum poisoning. This case aims to elucidate the potential pathophysiological link between superwarfarin intoxication and the development of aortic dissection.

A 69-year-old man was admitted to the hospital with a 9-day history of oral bleeding and an 8-day history of pain in the lower back, abdomen, and chest. Initial examinations at another facility were inconclusive. Upon transfer to our hospital, computed tomography angiography (CTA) revealed an extensive aortic dissection extending from the distal abdominal aorta to the bilateral iliac arteries. Key coagulation tests on admission indicated severe coagulopathy: both prothrombin time (PT) and the international normalized ratio (INR) were undetectable, and the activated partial thromboplastin time (APTT) was markedly prolonged to 160.1 s. Concurrent hematological tests revealed anemia (hemoglobin 102 g/L). Toxicological screening confirmed the presence of Brodifacoum in his blood. The patient's condition was stabilized through aggressive management, including infusion of fresh frozen plasma (FFP), high-dose intravenous vitamin K, and strict blood pressure control. His coagulation parameters gradually normalized over two weeks.

This case highlights a life-threatening complication of superwarfarin poisoning-aortic dissection. It underscores the critical importance of considering toxicological etiologies in patients with unexplained coagulopathy. Early reversal of the coagulation deficit and rigorous blood pressure control are paramount in preventing the progression of dissection.