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4 There are 3 major groups of superwarfarins: hydroxy coumarin derivatives with a 4-bromo(1-1 biphenyl) side chain coumatetryls and indanediones. 3 Superwarfarins and warfarins concentrate in the liver on ingestion. Superwarfarins are long-acting, fat-soluble anticoagulants with a terminal half-life of at least 24.2 days and are 100 times more potent than warfarin. 1, 2 They are popular and readily available in stores and homes.

SUPERWARFARINS constitute a class of rodenticides developed in the 1970s to overcome resistance to warfarin in rats.

None of the patients in our study died of superwarfarin poisoning.Ĭonclusions Superwarfarin exposure or poisoning is a growing public health problem that should be part of the differential diagnosis of patients who present with a coagulopathy consistent with vitamin K deficiency in the absence of coumadin therapy, liver disease, or the use of an inhibitor, and whose conditions do not resolve with large doses of parenteral vitamin K 1 therapy. We examined and treated the patients with Munchausen syndrome for months before establishing a diagnosis and fully reversing the anticoagulation. Full reversal of anticoagulation was quickly achieved in the cases of accidental ingestion and attempted suicide. The patients who had accidentally ingested superwarfarin or attempted suicide using it were easily diagnosed, while diagnosis was markedly delayed for the 2 patients with Munchausen syndrome. Nine of the 11 cases had taken brodifacoum.

All 7 children included in the study had accidentally ingested superwarfarin, 2 adults had Munchausen syndrome, and 1 teenager and 1 adult had attempted suicide using superwarfarin. Results Eleven cases satisfied the criteria for superwarfarin exposure or poisoning. Patients and Methods Patients from northern Wisconsin with superwarfarin exposure or poisoning were examined at a tertiary referral center in rural Wisconsin to determine what led to their exposure and to review the clinical manifestations, diagnosis, treatment, and prevention of superwarfarin poisoning. Cases may be associated with accidental exposure, suicide attempts, or Munchausen syndrome, and may be difficult to diagnose.

There were 5133 reported cases of superwarfarin exposure and poisoning in 193 cases in 1995.