{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T05:51:01Z","timestamp":1774763461437,"version":"3.50.1"},"reference-count":19,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2014,9,23]]},"abstract":"<jats:p>Difenacoum is a long-acting superwarfarin-type anticoagulant that exerts its effect through inhibiting vitamin K 2,3-epoxide reductase. Inhibition of this enzyme leads to reduced bioavailability of the metabolically active form of vitamin K resulting in decreased production of vitamin K-dependent proteins including coagulation factors II, VII, IX and X. A 45-year-old woman with psychiatric illness presented with haematuria. Laboratory test results indicated she had been exposed to a vitamin K antagonist which was subsequently identified as difenacoum. She was initially treated with phytomenadione, red cell suspension and octaplex. She was discharged on 30\u2005mg phytomenadione daily but monitoring of vitamin K markers indicated that compliance was poor, and 152\u2005days post-admission she presented with haemoptysis. Difenacoum and other superwarfarin rodenticides are freely available for purchase by the public. Cases such as this continue to raise issues about their availability and regulation.<\/jats:p>","DOI":"10.1136\/bcr-2014-206360","type":"journal-article","created":{"date-parts":[[2014,10,13]],"date-time":"2014-10-13T11:07:54Z","timestamp":1413198474000},"page":"bcr2014206360","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Superwarfarin poisoning and its management"],"prefix":"10.1136","volume":"2014","author":[{"given":"David John","family":"Card","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Francis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krutika","family":"Deuchande","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominic Jon","family":"Harrington","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,10,13]]},"reference":[{"key":"2025042706415857000_2014.oct13_1.bcr2014206360.1","first-page":"74","article-title":"A brief account of a disease in cattle simulating hemorrhagic septicaemia due to feeding sweet clover","volume":"3","author":"Schofield","year":"1922","journal-title":"Can Vet J"},{"key":"2025042706415857000_2014.oct13_1.bcr2014206360.2","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1152\/ajplegacy.1931.96.2.413","article-title":"A problem in the coagulation of the blood; sweet clover disease of the cattle","volume":"96","author":"Roderick","year":"1931","journal-title":"Am J Physiol"},{"key":"2025042706415857000_2014.oct13_1.bcr2014206360.3","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/S0021-9258(18)51377-6","article-title":"Studies of the hemorrhagic sweet clover disease: V. 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