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Within each of the three arms of the coagulation cascade, certain clotting factors are dependent on vitamin K for activity. These include factor VII, factor XI and factors II and X in the extrinsic, intrinsic and common pathways respectively. Vitamin K carboxylates these factors to their fuctional forms, and in the process itself becomes oxidised. Vitamin K is always required for the production of new II, VII, IX, and X in the liver and levels are tightly regulated. It is therefore essential that vitamin K is recycled after it is oxidised in the carboxylation reaction, and the enzyme vitamin K epoxide reductase is respsonsible for this.
 
Within each of the three arms of the coagulation cascade, certain clotting factors are dependent on vitamin K for activity. These include factor VII, factor XI and factors II and X in the extrinsic, intrinsic and common pathways respectively. Vitamin K carboxylates these factors to their fuctional forms, and in the process itself becomes oxidised. Vitamin K is always required for the production of new II, VII, IX, and X in the liver and levels are tightly regulated. It is therefore essential that vitamin K is recycled after it is oxidised in the carboxylation reaction, and the enzyme vitamin K epoxide reductase is respsonsible for this.
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Anticoagulant rodenticides inhibit vitamin K epoxide reductase, preventing the recyling of vitamin K and depriving the liver of the active, reduced form of the vitamin<sup>1-5</sup>. Activation of factors II, VII, IX and X ceases, but there is a quantity of these already in the circulation that are not affected. A time-lag therefore exists between ingestion of anticoagulant rodenticide and the clinical manifestation of toxicity (unchecked haemorrhage), while the supply of still-viable, vitamin K-dependent clotting factors reach the end of their life span. This delay is around 5 days in length<sup>3</sup>.  
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Anticoagulant rodenticides competitively inhibit vitamin K epoxide reductase<sup>4</sup>, preventing the recyling of vitamin K and depriving the liver of the active, reduced form of the vitamin<sup>1-6</sup>. Activation of factors II, VII, IX and X ceases, but there is a quantity of these already in the circulation that are not affected. A time-lag therefore exists between ingestion of anticoagulant rodenticide and the clinical manifestation of toxicity (unchecked haemorrhage), while the supply of still-viable, vitamin K-dependent clotting factors reach the end of their life span. This delay is around 5 days in length<sup>3</sup>.  
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Since factor VII has a half-life of only 6 hours, the extrinsic pathway is the first to be affected. This causes slight impatirement of haemostasis is impaired slightly giving a mild degree of haemorrhage, but the intrinsic pathway is still functional and is able to prevent the development of overt clinical signs.  
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Since factor VII has a half-life of only 6 hours, the extrinsic pathway is the first to be affected. This causes slight impatirement of haemostasis is impaired slightly giving a mild degree of haemorrhage, but the intrinsic pathway is still functional and is able to prevent the development of overt clinical signs. After around 14 hours, factor IX of the intrinsic pathway reaches the end of its life-span, and this pathway ceases to operate. Haemorrhage can then proceed unchecked, and clinical signs become obvious.
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Once the lifespan of factor IX (in the back-up intrinsic path) is at an end (half-life 13.9 hours), that pathway will be shut down and be defunct. It is at this point that hemorrhage begins to go unchecked and the most common time that the first signs of observable clinical abnormalities are noted. It is also at this point that laboratory evaluation of the blood will reveal an elevated partial thromboplastin time (PTT or APTT) as representative of a defect within that particular (intrinsic) pathway. PT is still elevated. From this point, deterioration of the patient due to hemorrhage may be quite rapid (assuming that no more active vitamin K is added to the system).
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The coumarin derivatives exert interaction of
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their anticoagulant eftect by inhibiting the enzyme, vitamin K epoxide reductase (see box on page 63). This enizymiie is a component of
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the vitamin K epoxide cycle required tf)r hepatic synthesis
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of the functional clotting factors F-II, F-VII, F-IX and
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F-X. Inhibition of the enzyme causes the accumulation of the inactive vitamin K epoxide and prevents the carboxylation
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of vitamin K-dependent coagulation proteins. The
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acarboxy precursor proteins are incapable of being activated
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during the coagulation process and thus cannot
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actively participate in fibrin formation.
       
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