CUMARIN POISONING: A SCIENTIFIC REVIEW

Abstract

This chapter presents a scientific review of coumarin poisoning in humans, addressing its pathophysiology, clinical presentation, diagnosis, and management. Coumarins, vitamin K antagonists, inhibit hepatic synthesis of coagulation factors II, VII, IX, and X, resulting in coagulopathy.¹ Poisoning can be accidental or intentional, constituting a significant public health problem.³ Diagnosis is based on clinical history and elevated prothrombin time (PT) and international normalized ratio (INR). ² Treatment involves supportive measures and the administration of vitamin K1 (phytomenadione) as an antidote.² In cases of severe bleeding, replacement of coagulation factors with Prothrombin Complex Concentrate (PCC) or Fresh Frozen Plasma (FFP) is crucial.⁵ A particular challenge is the management of poisoning by "superwarfarin" high-potency second-generation rodenticides with a prolonged half-life, which require long-term therapy.⁶ The epidemiology in Brazil is complex due to the prevalence of illegal rodenticides ("chumbinho"), which often contain other toxic substances, masking the real profile of coumarin poisoning and requiring diagnostic attention.⁸