SURREPTITIOUS SUPERWARAFARIN POISONING WITH BRODIFACOUM

Because of the emergence of warfarin resistance in rodents, second-gen eration anticoagulants named ''superwarfarins'' were developed and mar keted in over-the-counter rodenticide products, The availability of th ese compounds has resulted in accidental or intentional human ingestio ns, which cause severe bleeding. The methods for diagnosis and treatme nt of patients using superwarfarins are different from those for patie nts taking the regular warfarins. We report a case of intentional supe rwarfarin ingestion that caused petechiae and hematuria. Although the patient denied taking anticoagulant, the persistence of vitamin K-depe ndent factor deficiency led us to investigate the serum for anticoagul ant rodenticides. We found high levels of brodifacoum, a superwarfarin compound. This case emphasizes the need for suspicion of superwarfari n poisoning in patients who show unexplained bleeding due to deficienc y of vitamin K-dependent factors and resistance to treatment.