title: A 44-year-old woman with hematemesis and cutaneous hemorrhages as a result of superwarfarin poisoning.
abstract: The authors present the case of a 44-year-old American Indian woman with hematemesis, spontaneous cutaneous hemorrhages, and multiple ecchymoses. Coagulation factor analyses demonstrated both prolonged prothrombin time (PT, >40 s) and prolonged partial thromboplastin time (PTT, >120 s). Measurement of the serum level of brodifacoum (37 ng/mL), one of the superwarfarin agents commonly used in rodenticides, confirmed poisoning as the cause of the patient's symptoms. Substantial amounts of fresh frozen plasma and vitamin K were required to obtain normal coagulation parameters and maintain these parameters over a 3-week inhospital period. Oral administration of vitamin K (100 mg daily) maintained normal PT (14.1 s), PTT (33.0 s), and international normalized ratio (INR, 1.48) at 2 weeks after the patient was discharged from the hospital. By 2 months postdischarge, PT, PTT, and INR returned to elevated levels because of patient noncompliance with the prescribed tapering vitamin K regimen.
authors.affiliation: Scott and White Memorial Hospital, 121 Meadowbrook Dr, Temple, TX 76502-5582, USA. bethdolin@aol.com
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Dolin
authors.forename: Damon L
authors.initials: DL
authors.lastname: Baker
authors.forename: Steven C
authors.initials: SC
authors.lastname: Buck
mesh_terms: D015110:4-Hydroxycoumarins / Q000506:poisoning*; D000328:Adult; D000925:Anticoagulants / Q000506:poisoning*; D005260:Female; D006396:Hematemesis / Q000139:chemically induced* / Q000628:therapy; D006470:Hemorrhage / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D011041:Poisoning / Q000628:therapy; D012871:Skin Diseases / Q000139:chemically induced* / Q000628:therapy
chemical_list: D015110:4-Hydroxycoumarins; D000925:Anticoagulants; C013418:bromfenacoum