Pragmatic Approach to Superwarfarin Intoxication in a Resource Constraint Setting; a Case Report

Introduction: superwarfarins are highly lethal rodenticides which are much more potent than the warfarin owing to various structuralchanges in the parent compound that confers high half-life and increase affinity to vitamin k epoxide.case presentation: we report a case of a 19 years old female who presented bleeding prolonged pt and aptt. factor assay showedsignificantly lower levels vitamin k dependent coagulation factors. she was given conventional doses of ffp and vitamin k for twoconsecutive days, although she responded clinically but her coagulation profile failed to show any improvement. hence superwarfarinpoisoning was considered. based on this assumption patient was cross questioned repeatedly, and subsequently she admitted that shehad ingested rodenticide with the suicidal intent. hence she was given higher doses of vitamin k and ffp for several days after whichher pt and aptt shortened significantly.discussion: superwarfarin toxicity clinically presents with bleeding and deranged coagulation profile. differentiating it from othercauses is challenging but very crucial, as it does not responds to usual doses of vitamin k and plasma.conclusion: this case highlights the importance of maintaining high index of suspicion of superwarfarin toxicity in coagulopathy ofunknown etiology that fails to respond to conventional doses of treatment. detailed history with interrogation of leading questions insuch cases is of integral importance.