Surreptitious Superwarfarin Ingestion With Brodifacoum
Surreptitious Superwarfarin Ingestion With Brodifacoum
Physicians must have a high index of suspicion when patients have unexplained prolongation of the prothrombin time and bleeding in the absence of detectable warfarin. Several common rodenticides contain modified versions of warfarin that are not detectable in standard warfarin assays. We present a case of surreptitious brodifacoum ingestion in a patient who had years of unexplained bleeding and negative warfarin levels.
Warfarin, since its introduction into clinical medicine in the early 1950s, has saved the lives of many patients with chronic atrial fibrillation, pulmonary embolism, deep venous thrombosis, or artificial heart valves. Safe administration of warfarin can be challenging for both physicians and patients. Surreptitious ingestion of excess warfarin or one of its congeners can present a particularly difficult diagnostic dilemma.
Physicians must have a high index of suspicion when patients have unexplained prolongation of the prothrombin time and bleeding in the absence of detectable warfarin. Several common rodenticides contain modified versions of warfarin that are not detectable in standard warfarin assays. We present a case of surreptitious brodifacoum ingestion in a patient who had years of unexplained bleeding and negative warfarin levels.
Warfarin, since its introduction into clinical medicine in the early 1950s, has saved the lives of many patients with chronic atrial fibrillation, pulmonary embolism, deep venous thrombosis, or artificial heart valves. Safe administration of warfarin can be challenging for both physicians and patients. Surreptitious ingestion of excess warfarin or one of its congeners can present a particularly difficult diagnostic dilemma.
