Anticoagulants ; poisoning ; Humans ; Male ; Middle Aged ; Rodenticides ; poisoning

Adolescent ; Adult ; Anticoagulants ; poisoning ; Coagulation Protein Disorders ; chemically induced ; diagnosis ; therapy ; Female ; Humans ; Male ; Rodenticides ; poisoning

No abstract available.
4-Hydroxycoumarins/*poisoning ; Anticoagulants/*poisoning ; Blood Coagulation/*drug effects ; Female ; Humans ; Male ; Rodenticides/*poisoning ; Vitamin K/*blood ; Vitamin K Deficiency Bleeding/*chemically induced

BACKGROUND/AIMS: Recently, many cases of vitamin K-dependent coagulopathy of unknown origin have been reported. Such patients lack any relevant family history and have no systemic disease, raising suspicion of superwarfarin intoxication. We evaluated individual risk factors causing coagulopathy and hemorrhagic symptoms in patients with suspected superwarfarin intoxication. In addition, we determined how to effectively treat vitamin K-dependent coagulopathy caused by suspected superwarfarin intoxication. METHODS: Seven patients with suspected superwarfarin intoxication who lacked any definitive history of rodenticide ingestion were included. Thirty-one patients initially diagnosed with rodenticide poisoning were also included. We performed a retrospective chart review of all subjects and examined clinical data including patient demographics and medical histories. RESULTS: Patients initially diagnosed with rodenticide poisoning were divided into two groups, one of which had a laboratory abnormality (prothrombin time [PT] > 13 seconds) and another group with PTs in the normal range. There was no significant difference between the two groups in any of age, gender, the extent of chronic alcohol consumption, the causative rodenticide, psychiatric problems, ingestion of drugs interacting with warfarin, the extent of intoxication, or the type of ingestion attempt. The albumin level of the former group was significantly lower than that of the latter group (p = 0.014). Furthermore, a significant difference between the two groups was evident in terms of simultaneous ingestion of rodenticide and alcohol (p = 0.023). CONCLUSIONS: Most patients with superwarfarin poisoning did not exhibit any complication. When such complications were evident, they were associated with serum albumin level and coingestion of rodenticide and alcohol.
4-Hydroxycoumarins/*poisoning ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking/adverse effects/blood ; Anticoagulants/*poisoning ; Blood Coagulation/*drug effects ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Partial Thromboplastin Time ; Prothrombin Time ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Rodenticides/*poisoning ; Serum Albumin/metabolism ; Vitamin K/*blood ; Vitamin K Deficiency Bleeding/blood/*chemically induced/diagnosis/therapy ; Young Adult

OBJECTIVETo establish a model of acute lung injury induced by paraquat poisoning and to observe the effects of anticoagulant therapy on acute lung injury induced by paraquat poisoning.

METHODSOne hundred twenty adult healthy male Wistar rats were randomly divided into three groups: the paraquat poisoning group was exposed intragastrically (IG) to 50 mg/kg paraquat, anticoagulant therapy group was exposed intragastrically (IG) to 50 mg/kg paraquat then administrated subcutaneously with 68 U/kg low molecular heparin calcium 2 times a day and administrated intragastrically with 1.67 mg/kg aspirin one tome a day for 3, 7, 14 and 21 days, respectively, control group exposed intragastrically to normal saline. After exposure the rats were sacrificed, the venous blood and lung tissues were collected to detect the prothrombin time, activated partial thromboplastin time, fibrinogen, thrombin time and D-dimer in blood and the hydroxyproline in lung tissues, and to examine pathological changes in lung tissues with HE and Masson staining under light microscope.

RESULTSAt the 3rd, 7th, 14th and 21st days after exposure, the hydroxyproline contents of lung tissues in paraquat poisoning group and anticoagulation therapy group were significantly higher than those in control group (P < 0.05), but the hydroxyproline contents of lung tissues in anticoagulation therapy group were significantly lower than those in paraquat poisoning group (P < 0.05). At the 3rd day after exposure, the PT, APTT, Fib and D-dimer levels in paraquat poisoning group and anticoagulation therapy group were significantly higher than those in control group (P < 0.05), the D-dimer level of anticoagulation therapy group was significantly lower than that of control group (P < 0.05). At the 7th, 14th and 21st days after exposure, the TT and D-dimer levels of paraquat poisoning group and anticoagulation therapy group were significantly higher than those of control group (P < 0.05), the TT and D-dimer levels of anticoagulation therapy group were significantly lower than those of paraquat poisoning group (P < 0.05). The lung injury in paraquat poisoning group increased with exposure period, the lung fibrosis in anticoagulation therapy group was lower than that in paraquat poisoning group.

CONCLUSIONAnticoagulation therapy can improve hyper-coagulation state and acute lung injury in rats induced by paraquat poisoning.

Acute Lung Injury ; chemically induced ; drug therapy ; Animals ; Anticoagulants ; therapeutic use ; Aspirin ; therapeutic use ; Disease Models, Animal ; Drug Therapy, Combination ; Heparin, Low-Molecular-Weight ; therapeutic use ; Male ; Paraquat ; poisoning ; Rats ; Rats, Wistar

This observational study aimed at evaluating recent superwarfarin intoxication of Korean patients. Ten patients were diagnosed as or highly suspicious for superwarfarin intoxication. Case report forms described by attending hematologists of the patients were collected and analyzed. Bleeding symptoms were varied among the patients. Patients uniformly showed prolonged prothrombin time (PT) and activated thromboplastin time (aPTT) with decreased activity of vitamin K dependent coagulation factors. Positive serum brodifacoum test results in 4 of 5 requested patients contributed to confirmatory diagnosis. Psychiatric interview revealed an attempted ingestion in one patient. High dose vitamin K1 therapy promptly corrected prolonged PT and aPTT, but hasty discontinuation caused repeated bleeding diathesis in 6 patients. Route of intoxication was unknown or not definite among 8 of 10 patients. Three patients had a possibility of environmental exposure considering their occupations: there might be intoxication by transdermal absorption or inhalation. Therefore, high dose and prolonged use of vitamin K1 therapy is necessary for effective detoxification. Further detailed investigation on environmental exposure and efforts to improve availability of the blood level test in clinic are requested.
4-Hydroxycoumarins/*poisoning ; Adult ; Aged ; Aged, 80 and over ; Anticoagulants/*poisoning ; Antifibrinolytic Agents/therapeutic use ; Environmental Exposure ; Female ; Hemorrhage/*chemically induced/diagnosis/drug therapy ; Humans ; Male ; Middle Aged ; Partial Thromboplastin Time ; Prothrombin Time ; Republic of Korea ; Treatment Outcome ; Vitamin K 1/therapeutic use