Purpose: Super warfarins are commonly ingested substances. Despite their potential for causing severe and prolonged coagulation defects, these abnormalities are rarely seen in the acute non-intentional poisoning case. Methods: A retrospective chart review was performed of all pediatric cases (age < 12 yrs) of superwarfarin ingestions reported to our institution's Regional Poison Control Center from September 1994-July 1995. Data collected included type of product and reported amount ingested. 48 hour follow up data were analyzed for signs and symptoms of bleeding from oral or anal sites and for bruising. Prothrombin time (PT) was also recorded if available. Results: A total of 317 cases met criteria though no 48 hour follow up data could be obtained for 59 patients. 44 patients were "dual" ingestions. Average age was 22 months (range 5 months to 8 years) with 299 patients less than 3 years of age. Amount ingested included: < 5 pellets - 128 patients; > 5 pellets to one half package - 114 patients; > one half package - 4 patients; unknown - 71 patients. None of the 258 patients for whom ≥ 48 hour follow up was performed demonstrated signs or symptoms of bleeding. PTs were indicated by current protocols (> 5 pellets or unknown amount) for 160 patients and performed on 102 patients with 88 patients having normal values. Results were unknown in 14 patients. The PT was documented in 49 cases with a mean of 12.34 seconds (range 10.8-16.0 seconds). Conclusion: Superwarfarin ingestion is common but clinical coagulnpathy is rarely seen. While most protocols recommend obtaining a PT at 48 hours post ingestion for > 5 pellets, we believe observation alone and PCC phone follow up (when phone available) is adequate in acute unintentional asymptomatic superwarfarin ingestions of < one half package. If these guidelines had been followed in our study, potential savings for PT alone would be approximately $9,000.
