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Surreptitious ingestion of a long-acting vitamin K antagonist/rodenticide,
brodifacoum: clinical and metabolic studies of three cases
JN Weitzel, JA Sadowski, BC Furie, R Moroose, H Kim, ME Mount, MJ Murphy and B Furie
Division of Hematology-Oncology, New England Medical Center, Boston, MA.
The vitamin K metabolism of three patients with factitious purpura due to
brodifacoum ingestion was studied. These patients, who presented with
bleeding disorders due to deficiency of the vitamin K-dependent blood
clotting proteins, were refractory to vitamin K1 at standard doses and
required fresh frozen plasma to control bleeding until large doses of
vitamin K1 were used. Metabolic studies demonstrated a blockade in vitamin
K utilization, consistent with the presence of a vitamin K antagonist, but
the patients denied use of anticoagulants. Warfarin assays were negative.
We show that the factitious purpura in each patient was due to the
surreptitious ingestion of brodifacoum, a potent second generation
long-acting vitamin K antagonist used as a rodenticide. The coagulopathies
responded to long-term therapy with large doses of vitamin K1. The serum
elimination half-time for brodifacoum ranged from 16 to 36 days in these
patients. The anticoagulant effect is of long duration, requiring chronic
vitamin K treatment. With increasing availability of new rodenticides,
factitious purpura due to surreptitious ingestion of these potent vitamin K
antagonists is emerging as a new problem, previously associated with
warfarin, with important implications for diagnosis and treatment.
Volume 76,
Issue 12,
pp. 2555-2559,
12/15/1990
Copyright © 1990 by The American Society of Hematology
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