title: A prospective study of acute, unintentional, pediatric superwarfarin ingestions managed without decontamination.
abstract: OBJECTIVE
  We determine the incidence of clinically important bleeding in children with superwarfarin rodenticide ingestions not treated with gastrointestinal decontamination or prophylactic vitamin K.
  
  
  METHODS
  We prospectively studied patients younger than 6 years of age who reported to our poison center with acute unintentional superwarfarin ingestions. Patients who received gastrointestinal decontamination or prophylactic vitamin K were excluded. Forty-eight- to 96-hour prothrombin time or international normalized ratio (INR) blood tests were recommended, and telephone contact was attempted at least 3 days after ingestion.
  
  
  RESULTS
  A total of 595 consecutive patients were enrolled during the 16-month study period. Fifty patients were excluded: 8 who were known to have ingested 1 pellet or less; 25 who received activated charcoal; 15 who were treated with induced emesis; and 2 who received prophylactic vitamin K. The resulting study group contained 545 patients. Eighty-two patients were lost to follow-up. Follow-up was obtained for 463 patients, including 222 by telephone contact alone, 62 by 48- to 96-hour INR, and 179 by both methods. None of the patients had clinically important coagulopathy. Two patients had an INR of 1.5 or greater (1.5 and 1.8) without symptoms. Single nosebleeds were reported in another 2 patients with normal 48-hour INRs. Another child had a small amount of blood crusted in the nose with no other symptoms and no laboratory work available. One child with a normal 48-hour INR had blood-streaked stools that were thought to be caused by an anal fissure.
  
  
  CONCLUSIONS
  Children with acute unintentional superwarfarin ingestions of less than 1 box may be managed without gastric decontamination or prophylactic vitamin K. Laboratory testing for coagulopathy should be reserved for cases involving clinically evident bleeding abnormalities.
authors.affiliation: California Poison Control System, San Diego Division, San Diego, CA, USA.
authors.forename: Marianne
authors.initials: M
authors.lastname: Ingels
authors.forename: Chi
authors.initials: C
authors.lastname: Lai
authors.forename: Winnie
authors.initials: W
authors.lastname: Tai
authors.forename: Beth H
authors.initials: BH
authors.lastname: Manning
authors.forename: Cyrus
authors.initials: C
authors.lastname: Rangan
authors.forename: Saralyn R
authors.initials: SR
authors.lastname: Williams
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Manoguerra
authors.forename: Timothy
authors.initials: T
authors.lastname: Albertson
authors.forename: Richard F
authors.initials: RF
authors.lastname: Clark
mesh_terms: D015110:4-Hydroxycoumarins / Q000506:poisoning*; D000925:Anticoagulants / Q000506:poisoning*; D002648:Child; D002675:Child, Preschool; D003666:Decontamination / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D011041:Poisoning / Q000097:blood / Q000150:complications / Q000628:therapy*; D011446:Prospective Studies; D011517:Prothrombin Time; D012378:Rodenticides / Q000506:poisoning*; D016896:Treatment Outcome; D014812:Vitamin K / Q000008:administration & dosage
chemical_list: D015110:4-Hydroxycoumarins; D000925:Anticoagulants; D012378:Rodenticides; D014812:Vitamin K; C013418:bromfenacoum