Nosal Daniel G, van Breemen Richard B, Haffner John W, Rubinstein Israel, Feinstein Douglas L
Linus Pauling Institute, Oregon State University, Corvallis, OR, USA.
Department of Emergency Medicine, University of Illinois, Peoria, IL, USA.
Toxicol Commun. 2021;5(1):69-72. doi: 10.1080/24734306.2021.1887637. Epub 2021 Mar 1.
Standard of care follow-up therapy for patients poisoned by long-acting anticoagulant rodenticides (LAARs) is daily high-dose (up to 100 mg per day) oral vitamin K1 (VK) for weeks to months to over a year. The availability of CLIA-certified quantitative testing for plasma LAAR concentrations can now assist health care providers in determining when to safely discontinue VK therapy. We present estimates of treatment duration required to reach safe concentrations (< =10ng/ml) using serial measurements of plasma brodifacoum (BDF, a potent LAAR) concentrations obtained from patients poisoned after inhaling synthetic cannabinoids containing BDF. We fit the data to zero-order (linear) and first-order (exponential) curves, the latter to account for enterohepatic circulation of BDF. The results show that estimates of therapy duration are significantly longer when exponential clearance is assumed. Accordingly, we recommend that plasma BDF concentrations be monitored simultaneously with international normalization ratio (INR) during follow-up of poisoned patients, and that concentrations be determined after VK therapy is discontinued to document persistence of safe concentrations.
长效抗凝血灭鼠剂（LAARs）中毒患者的标准护理后续治疗是持续数周、数月甚至一年以上，每日口服大剂量（高达100毫克/天）维生素K1（VK）。现在，经临床实验室改进修正案（CLIA）认证的血浆LAAR浓度定量检测，可帮助医护人员确定何时安全停用VK治疗。我们根据吸入含溴敌隆（BDF，一种强效LAAR）的合成大麻素中毒患者的血浆溴敌隆浓度系列测量值，给出了达到安全浓度（<=10纳克/毫升）所需治疗持续时间的估计值。我们将数据拟合为零级（线性）和一级（指数）曲线，后者用于考虑BDF的肠肝循环。结果表明，假设指数清除时，治疗持续时间的估计值明显更长。因此，我们建议在中毒患者随访期间，同时监测血浆BDF浓度和国际标准化比值（INR），并在停用VK治疗后测定浓度，以记录安全浓度的持续情况。
