Super Warfarin Poisoning

CDC hazardous chemical category long-acting anticoagulant 

Decreases activity of vitamin K-dependent blood clotting factors II, VII, IX, and X 

Bowel movements - blood or black (hematochezia) (melena) Mouth, gingiva - bleeding Nose - blood (epistaxis) 

Skin - ecchymoses Skin - rash, petechiae Sputum - blood (hemoptysis) 

Blood factor II - decreased Blood factor VII - decreased Blood factor IX - decreased Blood factor X - decreased 

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Greeff, M.C., Mashile, O., MacDougall, L.G. (1987). Super-warfarin (bromodialone) poisoning in two children resulting in prolonged anticoagulation. Lancet ii(8570) 1269. 

Resistance to coumarin anticoaguiants. Subjects of this rare inherited abnormality possess a variant of the enzyme that coverts vitamin K to its reduced and active form, which enzyme the coumarins normally inhibit patients require 20 times or more of the usual dose to obtain an adequate clinical response. A similar condition also occurs in rats and has practical importance as warfarin, a coumarin, is used as a rat poison (rats with the gene are dubbed super-rats by the mass media). 

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