Epidemiology and symptomatology of long acting anticoagulant rodenticide poisoning

Abstract

Background: Long acting anticoagulant rodenticides (LAARs) are widely used pesticides that initiate anticoagulation through avitamin K antagonist (VKA) mechanism. Human exposures produce presentations ranging from asymptomatic to fatal.

Methods: A comprehensive literature search and search of relevant databases was conducted. Data related to epidemiology ofLAAR exposure as well as clinical manifestations of LAAR poisoning and clinical management were extracted.

Results: Between 1987 and 2012, 315,951 total exposures were reported to the American Association of Poison ControlCenters. Of these, 95.6% were unintentional and 88.9% occurred in children under the age of six. Moderate or major effectsoccurred in only 0.6% of human LAAR exposures. Of reviewed case reports, the most common hemorrhagic manifestationswere mucocutaneous. Fatalities were most commonly associated with intracranial hemorrhage and intentional misuse. Multipleroutes of exposure have been reported including oral, percutaneous, and inhalational. Treatment courses required prolongedadministration of high dose vitamin K.

Conclusions: Most instances represent unintentional LAAR exposures among children. Although the majority of exposures areasymptomatic, serious coagulopathy may occur, and LAAR poisoning may not immediately be considered as an etiology. Aheightened awareness for this entity and awareness of diagnosis and treatment principles are critical to appropriate management.