SUPERWARFARIN POISONING LEADING TO PROLONGED COAGULOPATHY

An elderly Chinese was admitted for haemetemesis. Investigations revea led markedly prolonged clotting times that recurred every few days des pite administration of fresh frozen plasma and vitamin K. The derangem ent in coagulation lasted more than 3 months. In view of the absence o f liver disease or malabsorption syndromes, long-acting anticoagulant ('superwarfarin') ingestion was suspected. The diagnosis of rodenticid e poisoning was hampered by the lack of available assays. Diagnosis of brodifacoum intoxication using HPLC was confirmed only months after p rolonged treatment with high dose vitamin K-1. Superwarfarin poisoning should be suspected in cases of deranged coagulation refractory to tr eatment since these over-the-counter rodenticides are easily available .