Connecticut medicine
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Connecticut medicine · Apr 2008
Case ReportsAcquired deficiency of vitamin K-dependent clotting factors due to brodifacoum ingestion.
Brodifacoum, also known as a superwarfarin, is a four-hydroxycoumarin derivative. It exerts an anticoagulant effect by inhibiting the reduction of vitamin K-2,3 epoxide, thereby decreasing the production of vitamin K-dependent clotting factors. It is a readily available rodenticide that has been associated with accidental ingestions in children. ⋯ We followed the brodifacoum level, which decreased to 31 ng/ml approximately six weeks after initial presentation. The exact length of treatment required to prevent recurrence of the coagulopathy was not determined because the patient did not return for follow-up. Superwarfarin ingestion must be suspected and quickly identified in patients with depletion of vitamin K-dependent clotting factors resulting in potentially catastrophic bleeding.
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We reviewed medical examiner, law enforcement, crime laboratory data, and death certificates on all 1,530 violent deaths (homicide, suicide, undetermined firearm) in Connecticut occurring from 2001-2004. There was an average of 383 deaths (rate = 11.2 deaths per 100,000 persons annually). Overall, males aged 20 to 29 were at the greatest risk of violent death (rate = 30.5/100,000). ⋯ Firearms were used in 33% of suicides and 58% of homicides. The rate of violent death is lower than most other states in the country. In Connecticut suicide is the leading cause of violent death overall; however, in areas characterized by the highest levels of poverty and lowest levels of education, homicide is the leading cause of violent death.