Exposure to Superwarfarins in Rodentisides: Development of Prolonged Bleeding Defect in an Adolescent

124 Superwarfarins have been in use by mid-1970 throughout the world as anticoagulant rodenticides and pesticides in agricultural and urban rodent control. These anticoagulants include second generation 4-hydroxycoumarins like brodifacoum (BDF) and difenacoum (DFC).1,2 They inhibit the synthesis of clotting factors II, VII, IX and X. Superwarfarins were synthesized after development of warfarin resistance among rat populations.2 They are more potent than warfarin and they have prolonged anticoagulant effect.3 They have greater affinity for vitamin K(1)-2,3-epoxide reductase, they break this vitamin, accumulate in the liver, have long biological halflives due to high lipid solubility and enterohepatic circulation. In children and adolescents, exposure may be accidental, secondary (by rat feces), as a reExposure to Superwarfarins in Rodentisides: Development of Prolonged Bleeding Defect in an Adolescent