Document Type : Original Article
Authors
- . Simin Dashti-Khavidaki 1
- . Saba Ghaffari 2
- . Mohsen Nassiri-Toossi 3
- . Mohsen Amini 4
- . Maryam Edalatifard 5
1 Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Gastroenterology, ImamKhomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
4 Department of Medicinal Chemistry, Tehran University of Medical Sciences, Tehran, Iran
5 Department of Internal Medicine, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Superwarfarin toxicity may be a serious problem. It needs high clinical suspicious in patients
with bleeding diathesis without hematologic or liver diseases even in patients with apparent
negative history of warfarin or other anticoagulant accessibility. Here we reported a
patient with a negative history of any medical diseases or drug administration who was
referred with generalized ecchymosis. Increased international normalized ratio and decreased
vitamin K‑dependent coagulation factors were detected in this patient. His hematologic and
liver evaluations were normal. Clinical pharmacist emphasis in taking history revealed using
anticoagulant rodenticide all over the farm the patient lived in that might result in unaware
intoxication in this patient who suffered dementia.
Keywords
anticoagulants active against resistant rats. Nature
1975;253:275‑7.
2. Veenstra GE, Owen DE, Huckle KR. Metabolic and
toxicological studies on the anticoagulant rodenticide,
flocoumafen. Arch Toxicol Suppl 1991;14:160‑5.
3. Chua JD, Friedenberg WR. Superwarfarin poisoning. Arch
Intern Med 1998;158:1929‑32.
4. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL,
Rumack BH, Giffin SL. 2008 Annual report of the American
association of poison control centers’ national poison data
system (NPDS): 26th annual report. Clin Toxicol (Phila)
2009;47:911‑1084.
5. Spahr JE, Maul JS, Rodgers GM. Superwarfarin poisoning: A
report of two cases and review of the literature. Am J Hematol
2007;82:656‑60.
6. Babcock J, Hartman K, Pedersen A, Murphy M, Alving B.
Rodenticide‑induced coagulopathy in a young child. A case
of Munchausen syndrome by proxy. Am J Pediatr Hematol
Oncol 1993;15:126‑30.
7. Altay S, Cakmak HA, Boz GC, Koca S, Velibey Y. Prolonged
coagulopathy related to coumarin rodenticide in a young
patient: Superwarfarin poisoning. Cardiovasc J Afr
2012;23:e9‑e11.
8. Lee JH, Kim H, Han HS, Lee KH, Kim ST. A case of
superwarfarin intoxication without a definitive history of
brodifacoum exposure. Korean J Hematol 2009;44:53‑7.
9. Freeman WD, Aguilar M, Weitz J. Reversal of anticoagulation
in warfarin associated intracerebral hemorrhage. In: Basow DS,
editor. UptoDate. 2014. Available from: http://www.Uptodate.
com/home/index.html. [Last accessed on 2014 May 01].
10. Drews RE. Approach to the adult patient with a bleeding
diathesis. In: Basow DS, editor. UptoDate. 2014. Available from:
http://www.Uptodate.com/home/index.html. [Last accessed
on 2014 May 01].
11. Dashti‑Khavidaki S, Khalili H, Hamishekar H, Shahverdi S.
Clinical pharmacy services in an Iranian teaching hospital:
A descriptive study. Pharm World Sci 2009;31:696‑700.
12. Zeraatchi A, Talebian MT, Nejati A, Dashti‑Khavidaki S.
Frequency and types of the medication errors in an academic
emergency department in Iran: The emergent need for clinical
pharmacy services in emergency departments. J Res Pharm
Pract 2013;2:118‑22.