Acquired coagulopathy caused by intoxication with the superwarfarin-type anticoagulant rodenticide flocoumafen.

摘要: A 28 year-old heretofore healthy woman was transferred to our hospital with a two-month history of recurring episodes bleeding. Administration vitamin K and prothrombin complex concentrates in the transferring had only temporarily corrected both markedly elevated international normalized ratio (INR) prolonged activated partial thromboplastin time (aPTT). The patient's medical family revealed no reason for these abnormalities. Our laboratory analyses sustained deficiency K-dependent clotting factors. Presence an acquired inhibitor factors excluded. Thus we suspected, intoxication anticoagulant rodenticide. Liquid chromatography-mass spectrometry (LC-MS/MS) pharmacologically active concentrations flocoumafen, rodenticide belonging superwarfarin family, serum. While long elimination half-life superwarfarins is well described rodents, information on pharmacokinetics humans not yet available. Therefore, patient management limited administration K, but also included repeated measurements flocoumafen serum levels. During follow-up visits, tests remained normal levels gradually decreased, reaching limit quantification after 48 days. Based levels, 6.7 days estimated patient, which clear contrast 220 reported rodents. Thus, monitoring affected patients may provide rational basis duration substitution adequate intervals.