Kotsaftis Panagiotis, Girtovitis Fotios, Boutou Afroditi, Ntaios George, Makris Pantelis E
1st Department of Propedeutics in Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Eur J Haematol. 2007 Sep;79(3):255-7. doi: 10.1111/j.1600-0609.2007.00904.x. Epub 2007 Jul 26.
Superwarfarins are widely used as rodenticides. They are similar to warfarin, but they are more potent and act longer. In case of poisoning, they cause severe bleeding, usually from multiple sites.
A 67-yr-old man was admitted with melaena, epistaxis and haemarthrosis in his left knee. PT, INR and aPTT were markedly increased. Initially, the patient was treated with blood and fresh frozen plasma (FFP) transfusions. However at the second day, PT, INR and aPTT were even worse. The combination of persistent coagulopathy, normal mixing studies, normal liver function tests and absence of hepatic failure or malabsorption syndromes lead to the suspicion of vitK dependent clotting factors deficiency due to superwarfarin poisoning. Indeed, the patient admitted a suicide attempt with rodenticide, although he had previously denied it. Psychiatric evaluation revealed a disturbed personality. Melaena stopped after 7 d. Then, the patient was administered 30 mg of vitK daily for a total period of 4 months.
Superwarfarin poisoning leads to severe bleeding, usually from multiple sites. Prolonged treatment with high doses of vitK is necessary. Haemarthrosis, as a complication of superwarfarin poisoning, is presented here for the first time in literature.
超级华法林被广泛用作灭鼠剂。它们与华法林相似，但效力更强且作用时间更长。中毒时，它们会导致严重出血，通常是多部位出血。
一名67岁男性因黑便、鼻出血和左膝关节积血入院。凝血酶原时间（PT）、国际标准化比值（INR）和活化部分凝血活酶时间（aPTT）显著升高。最初，患者接受了输血及新鲜冰冻血浆（FFP）输注治疗。然而，第二天PT、INR和aPTT情况更糟。持续存在的凝血障碍、正常的混合试验、正常的肝功能检查以及无肝衰竭或吸收不良综合征，导致怀疑是超级华法林中毒引起的维生素K依赖凝血因子缺乏。事实上，患者承认曾企图服用灭鼠剂自杀，尽管他之前否认了此事。精神科评估显示其人格障碍。黑便在7天后停止。随后，患者每天服用30毫克维生素K，共持续4个月。
超级华法林中毒会导致严重出血，通常是多部位出血。需要用高剂量维生素K进行长期治疗。关节积血作为超级华法林中毒的一种并发症，本文首次在文献中报道。
