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Case Reports: Reminder of important clinical lesson
Superwarfarin poisoning: challenges still remain
  1. Ariadna de Genover Gil1,
  2. Gabriel Manuel Gonzalez Suarez2,
  3. Carla Moret Puig3 and
  4. Abelardo Hurtado Ganoza1
  1. 1Internal Medicine, Doctor Josep Trueta University Hospital of Girona, Girona, Spain
  2. 2Nephrology, Doctor Josep Trueta University Hospital of Girona, Girona, Spain
  3. 3Haematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain
  1. Correspondence to Ariadna de Genover Gil; agenover.girona.ics{at}gencat.cat

Abstract

Superwarfarin (long-acting anticoagulant rodenticide) poisoning should be suspected in unexplained bleeding with prolonged prothrombin time, especially in the absence of another explanation. Diagnosis and treatment of this intoxication remain a challenge as the direct analysis of superwarfarin in serum is not always possible. Therefore, toxin bioavailability remains unknown and close monitoring and treatment for long periods are required to avoid serious bleeding complications. Here, we discuss a case of suspected superwarfarin poisoning to highlight the challenges in early diagnosis and the challenges we encountered in treatment management and ensuring compliance for long periods.

  • Haematology (incl blood transfusion)
  • Drugs and medicines
  • Poisoning
  • Exposures

https://doi.org/10.1136/bcr-2021-248385

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    Footnotes

    • Contributors AdGG and GMGS conceived the presented idea. This was also discussed with AHG who encouraged AdGG and GMGS to investigate superwarfarin poisoning and supervised the findings of this work as well as helped with the planning. AdGG, GMGS and AHG made the acquisition of data and review the literature. CMP analysed and supported the interpretation of the patient’s data regarding the haematological aspects. The main paper was written and designed by AdGG and GMGS. The design of the figures was done by AdGG and GMGS, AHG and CMP helped supervise the project and revised the manuscript critically for important intellectual content. All authors approved final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.