title: Evaluation of risk factors in patients with vitamin K-dependent coagulopathy presumed to be caused by exposure to brodifacoum.
abstract: OBJECTIVE
  Recently, many cases of vitamin K-dependent coagulopathy of unknown origin have been reported. Such patients lack any relevant family history and have no systemic disease, raising suspicion of superwarfarin intoxication. We evaluated individual risk factors causing coagulopathy and hemorrhagic symptoms in patients with suspected superwarfarin intoxication. In addition, we determined how to effectively treat vitamin K-dependent coagulopathy caused by suspected superwarfarin intoxication.
  
  
  METHODS
  Seven patients with suspected superwarfarin intoxication who lacked any definitive history of rodenticide ingestion were included. Thirty-one patients initially diagnosed with rodenticide poisoning were also included. We performed a retrospective chart review of all subjects and examined clinical data including patient demographics and medical histories.
  
  
  RESULTS
  Patients initially diagnosed with rodenticide poisoning were divided into two groups, one of which had a laboratory abnormality (prothrombin time [PT] > 13 seconds) and another group with PTs in the normal range. There was no significant difference between the two groups in any of age, gender, the extent of chronic alcohol consumption, the causative rodenticide, psychiatric problems, ingestion of drugs interacting with warfarin, the extent of intoxication, or the type of ingestion attempt. The albumin level of the former group was significantly lower than that of the latter group (p = 0.014). Furthermore, a significant difference between the two groups was evident in terms of simultaneous ingestion of rodenticide and alcohol (p = 0.023).
  
  
  CONCLUSIONS
  Most patients with superwarfarin poisoning did not exhibit any complication. When such complications were evident, they were associated with serum albumin level and coingestion of rodenticide and alcohol.
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Hee-Jeong
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Mi-Ra
authors.initials: MR
authors.lastname: You
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Woo-Ram
authors.initials: WR
authors.lastname: Moon
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Hyoung
authors.initials: H
authors.lastname: Sul
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Choon-Hae
authors.initials: CH
authors.lastname: Chung
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Chi-Young
authors.initials: CY
authors.lastname: Park
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Sang-Gon
authors.initials: SG
authors.lastname: Park
mesh_terms: D015110:4-Hydroxycoumarins / Q000506:poisoning*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects / Q000097:blood; D000925:Anticoagulants / Q000506:poisoning*; D001777:Blood Coagulation / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011517:Prothrombin Time; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012378:Rodenticides / Q000506:poisoning*; D012709:Serum Albumin / Q000378:metabolism; D000075462:Serum Albumin, Human; D014812:Vitamin K / Q000097:blood*; D006475:Vitamin K Deficiency Bleeding / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D055815:Young Adult
chemical_list: D015110:4-Hydroxycoumarins; C422455:ALB protein, human; D000925:Anticoagulants; D012378:Rodenticides; D012709:Serum Albumin; D014812:Vitamin K; C013418:bromfenacoum; D000075462:Serum Albumin, Human
keywords: Brodifacoum; Poisoning; Vitamin K deficiency bleeding