Anticoagulant rodenticide poisoning: Clinical manifestations and diagnosis
- Diane P Calello, MD
Diane P Calello, MD
- Executive and Medical Director
- New Jersey Poison Information and Education System
- Section Editor
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic reviews the clinical manifestations and diagnosis of anticoagulant rodenticide poisoning.
The management of anticoagulant rodenticide poisoning and an overview of rodenticide poisonings other than anticoagulant rodenticides is provided separately. (See "Overview of rodenticide poisoning".)
Anticoagulant compounds are the most commonly used rodenticides in most of the world. The process of controlling rodent populations is imperative to human health but poses challenges when the rodenticide compounds used are also toxic to humans and domestic animals. The ideal rodenticide is highly toxic to rodents in small amounts but relatively nontoxic in small quantities to non-target species. The anticoagulant rodenticides best fit this criteria . Anticoagulant rodenticides came into use in the 1940s with the use of warfarin. The emergence of warfarin-resistant rats prompted the development of superwarfarins, or long-acting anticoagulants such as brodifacoum, bromadiolone, and chlorophacinone. Because of their availability, anticoagulant rodenticides are also the most common cause of rodenticide poisoning exposures reported annually in resource-rich countries such as the United States and the United Kingdom [2,3].
In the United States, brodifacoum is the most frequently used anticoagulant rodenticide ; however, global differences exist. In the United Kingdom, difenacoum, brodifacoum, and bromadiolone are most common . In the developing world, the use of warfarin rodenticides has led to tragic inadvertent exposures in newborns as well as the ingestion of contaminated foodstuff with resultant fatalities [6,7].
Throughout the world, the overwhelming majority of anticoagulant rodenticide exposures occur in young children, who generally ingest small volumes and have no significant coagulopathy [4,7-9]. However, patients with intentional or occupational exposures develop coagulopathy much more frequently.
- Hayes WJ. Pesticides Studied in Man, Williams & Wilkins, Baltimore 1982.
- Dawson A, Garthwaite D. Rodenticide usage by local authorities in Great Britain. In: Pesticide Usage Survey Report 185, F.a.R.A. Department for Environment (Ed). York UK 2001.
- Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2011 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 29th Annual Report. Clin Toxicol (Phila) 2012; 50:911.
- Mowry JB, Spyker DA, Cantilena LR Jr, et al. 2013 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 31st Annual Report. Clin Toxicol (Phila) 2014; 52:1032.
- Dawson A, Garthwaite D. Rodenticide usage by local authorities in Great Britain. In: Pesticide Usage Survey Report 185, F.a.R.A. Department for Environment (Ed), York UK 2001.
- Martin-Bouyer G, Khanh NB, Linh PD, et al. Epidemic of haemorrhagic disease in Vietnamese infants caused by warfarin-contaminated talcs. Lancet 1983; 1:230.
- Watt BE, Proudfoot AT, Bradberry SM, Vale JA. Anticoagulant rodenticides. Toxicol Rev 2005; 24:259.
- Smolinske SC, Scherger DL, Kearns PS, et al. Superwarfarin poisoning in children: a prospective study. Pediatrics 1989; 84:490.
- Mullins ME, Brands CL, Daya MR. Unintentional pediatric superwarfarin exposures: do we really need a prothrombin time? Pediatrics 2000; 105:402.
- Caravati EM, Erdman AR, Scharman EJ, et al. Long-acting anticoagulant rodenticide poisoning: An evidence-based consensus guideline for out-of-hospital management. Clinical Toxicol (Phila) 2007; 45:1.
- Yip L. Anticoagulant rodenticides. In: Medical Toxicology, Dart RC, Caravati EM, McGuigan MA (Eds), Lippincott Williams & Wilkins, Philadelphia 2004. p.1497.
- Leck JB, Park BK. A comparative study of the effects of warfarin and brodifacoum on the relationship between vitamin K1 metabolism and clotting factor activity in warfarin-susceptible and warfarin-resistant rats. Biochem Pharmacol 1981; 30:123.
- Bruno GR, Howland MA, McMeeking A, Hoffman RS. Long-acting anticoagulant overdose: brodifacoum kinetics and optimal vitamin K dosing. Ann Emerg Med 2000; 36:262.
- Lai M, Ewald M. Anticoagulants. In: Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose, Shannon MW, Borron SW, Burns MJ (Eds), Saunders, 2007. Vol 1051.
- Vandenbroucke V, Bousquet-Melou A, De Backer P, Croubels S. Pharmacokinetics of eight anticoagulant rodenticides in mice after single oral administration. J Vet Pharmacol Ther 2008; 31:437.
- Berny PJ, de Oliveira LA, Videmann B, Rossi S. Assessment of ruminal degradation, oral bioavailability, and toxic effects of anticoagulant rodenticides in sheep. Am J Vet Res 2006; 67:363.
- Spiller HA, Gallenstein GL, Murphy MJ. Dermal absorption of a liquid diphacinone rodenticide causing coagulaopathy. Vet Hum Toxicol 2003; 45:313.
- Hackett LP, Ilett KF, Chester A. Plasma warfarin concentrations after a massive overdose. Med J Aust 1985; 142:642.
- Hollinger BR, Pastoor TP. Case management and plasma half-life in a case of brodifacoum poisoning. Arch Intern Med 1993; 153:1925.
- Stanton T, Sowray P, McWaters D, Mount M. Prolonged anticoagulation with long-acting coumadin derivative: Case report of a brodifacoum poisoning with pharmacokinetic data. Blood 1988; 73:310a.
- Weitzel JN, Sadowski JA, Furie BC, et al. Surreptitious ingestion of a long-acting vitamin K antagonist/rodenticide, brodifacoum: clinical and metabolic studies of three cases. Blood 1990; 76:2555.
- Stanton T, Sowray P, McWaters D, Mount M. Prolonged anticoagulation with long-acting coumadin derivative: Case report of a brodifacoum poisoning with pharmacokinetic data. Blood 1988; 72:310a.
- Watts RG, Castleberry RP, Sadowski JA. Accidental poisoning with a superwarfarin compound (brodifacoum) in a child. Pediatrics 1990; 86:883.
- Su M. Anticoagulants. In: Goldfrank's Toxicologic Emergencies, 9th ed, Nelson LS, Lewin NA, Howland MA, et al (Eds), McGraw HIll Medical, New York 2011. p.861.
- Ingels M, Lai C, Tai W, et al. A prospective study of acute, unintentional, pediatric superwarfarin ingestions managed without decontamination. Ann Emerg Med 2002; 40:73.
- Svendsen SW, Kolstad HA, Steesby E. Bleeding problems associated with occupational exposure to anticoagulant rodenticides. Int Arch Occup Environ Health 2002; 75:515.
- Fristedt B, Sterner N. Warfarin intoxication from percutaneous absorption. Arch Environ Health 1965; 11:205.