The emerging threat of superwarfarins: history, detection, mechanisms, and countermeasures

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Compared to warfarin, superwarfarins have much longer half-lives and stronger affinity to vitamin K epoxide reductase and therefore can cause death in warfarin-resistant rodents. By the mid-1970s, the superwarfa …"><meta name="keywords" content="pmid:27244102, PMC4940222, doi:10.1111/nyas.13085, Review, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S., Douglas L Feinstein, Belinda S Akpa, Guy Weinberg, Animals, Anticoagulants / adverse effects, Anticoagulants / analysis, Anticoagulants / chemistry, Biomarkers / analysis, Environmental Exposure / analysis, Humans, Kidney / drug effects, Kidney / pathology, Nervous System / drug effects, Nervous System / pathology, Warfarin / adverse effects*, Warfarin / analysis*, Warfarin / chemistry, Warfarin / poisoning, PubMed Abstract, NIH, NLM, NCBI, National Institutes of Health, National Center for Biotechnology Information, National Library of Medicine, MEDLINE"><meta name="robots" content="index,nofollow,noarchive"><meta property="og:title" content="The emerging threat of superwarfarins: history, detection, mechanisms, and countermeasures - PubMed"><meta property="og:url" content="https://pubmed.ncbi.nlm.nih.gov/27244102/"><meta property="og:description" content="Superwarfarins were developed following the emergence of warfarin resistance in rodents. Compared to warfarin, superwarfarins have much longer half-lives and stronger affinity to vitamin K epoxide reductase and therefore can cause death in warfarin-resistant rodents. By the mid-1970s, the superwarfa …"><meta property="og:image" content="https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image-v2.jpg"><meta property="og:image:secure_url" content="https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image-v2.jpg"><meta property="og:type" content="website"><meta property="og:site_name" content="PubMed"><meta name="twitter:domain" content="pubmed.ncbi.nlm.nih.gov"><meta name="twitter:card" content="summary_large_image"><meta name="twitter:title" content="The emerging threat of superwarfarins: history, detection, mechanisms, and countermeasures - PubMed"><meta name="twitter:url" content="https://pubmed.ncbi.nlm.nih.gov/27244102/"><meta name="twitter:description" content="Superwarfarins were developed following the emergence of warfarin resistance in rodents. Compared to warfarin, superwarfarins have much longer half-lives and stronger affinity to vitamin K epoxide reductase and therefore can cause death in warfarin-resistant rodents. By the mid-1970s, the superwarfa …"><meta name="twitter:image" content="https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image-v2.jpg">  <link rel="search" type="application/opensearchdescription+xml" href="https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/opensearch.xml" title="PubMed search">  <noscript> <link rel="stylesheet" type="text/css" href="https://cdn.ncbi.nlm.nih.gov/pubmed/0d576970-ea4f-4f8d-9bab-bf51569c42d2/core/no-script.css"> </noscript> <meta name="citation_title" content="The emerging threat of superwarfarins: history, detection, mechanisms, and countermeasures"> <meta name="citation_authors" content="Feinstein DL;Akpa BS;Ayee MA;Boullerne AI;Braun D;Brodsky SV;Gidalevitz D;Hauck Z;Kalinin S;Kowal K;Kuzmenko I;Lis K;Marangoni N;Martynowycz MW;Rubinstein I;van Breemen R;Ware K;Weinberg G;"> <meta name="citation_date" content="2016 Jun"> <meta name="citation_publisher" content="Ann N Y Acad Sci"> <meta name="citation_journal_title" content="Annals of the New York Academy of Sciences"> <meta name="citation_pmid" content="27244102"> <meta name="citation_abstract_html_url" content="https://pubmed.ncbi.nlm.nih.gov/27244102/"> <meta name="citation_volume" content="1374"> <meta name="citation_issue" content="1"> <meta name="citation_doi" content="10.1111/nyas.13085"> <meta name="citation_issn" content="1749-6632"> <link rel="canonical" href="https://pubmed.ncbi.nlm.nih.gov/27244102/" /> </head> <body > <noscript> <div class="no-script-banner" id="no-script-banner"> <div class="warning-message"> <div class="warning-message-text"> This site needs JavaScript to work properly. 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new collection</label> </li> <li> <input type="radio" id="collections-action-panel-existing" class="collections-existing" name="collections" value="existing" checked="true" data-ga-category="save_share" data-ga-action="collections" data-ga-label="collections_radio_existing"> <label for="collections-action-panel-existing">Add to an existing collection</label> </li> </ul> </div> <div class="controls-wrapper"> <div class="action-panel-control-wrap new-collections-controls"> <label for="collections-action-panel-add-to-new" class="action-panel-label required-field-asterisk"> Name your collection: </label> <input type="text" name="add-to-new-collection" id="collections-action-panel-add-to-new" class="collections-action-add-to-new" pattern="[^"&=<>\/]*" title="The following characters are not allowed in the Name field: "&=<>/" maxlength="100" data-ga-category="save_share" data-ga-action="create_collection" data-ga-label="non_favorties_collection"> <div class="collections-new-name-too-long usa-input-error-message selection-validation-message"> Name must be less than 100 characters </div> </div> <div class="action-panel-control-wrap existing-collections-controls"> <label for="collections-action-panel-add-to-existing" class="action-panel-label"> Choose a collection: </label> <select id="collections-action-panel-add-to-existing" class="action-panel-selector collections-action-add-to-existing" data-ga-category="save_share" data-ga-action="select_collection" data-ga-label="($('#collections-action-add-to-existing').val() === 'Favorites') ? 'Favorites' : 'non_favorites_collection'"> </select> <div class="collections-retry-load-on-error usa-input-error-message selection-validation-message"> Unable to load your collection due to an error<br> <a href="#">Please try again</a> </div> </div> </div> <div class="action-panel-actions"> <button class="action-panel-submit" type="submit" data-loading-label="Adding..." data-pinger-ignore data-ga-category="save_share" data-ga-action="collections" data-ga-label="add"> Add </button> <button class="action-panel-cancel" aria-label="Close 'Add to Collections' panel" ref="linksrc=close_collections_panel" aria-controls="collections-action-panel" aria-expanded="false" data-ga-category="save_share" data-ga-action="collections" data-ga-label="cancel"> Cancel </button> </div> </form> </div> </div> <div id="bibliography-action-panel" class="bibliography-action-panel action-panel in-progress-dots-panel" aria-hidden="true" data-bibliography-open-panel-enabled="false" data-bibliography-open-panel-url-hash="#open-bibliography-panel"> <div class="inner-wrap"> <h3 class="action-panel-heading"> Add to My Bibliography </h3> <form id="bibliography-action-panel-form" class="bibliography-action-panel-form action-panel-content action-form action-panel-smaller-selectors" data-add-to-bibliography-max-amount="100" data-add-to-bibliography-batch-size="10" data-bibliography-delegates-url="/list-bibliography-delegates/" data-add-to-bibliography-url="/add-to-bibliography/" data-get-article-ids-by-search-url="/get-article-ids-by-search/" data-mybib-root-url="https://www.ncbi.nlm.nih.gov/myncbi/collections/mybibliography/"> <input type="hidden" name="csrfmiddlewaretoken" value="vMszhBsA2vedNsgXnOHJJdXXBKmcOORU4cHIPG4cCGpZ8mbc18r8ONh5CxyPQBWN"> <div class="action-panel-control-wrap bibliographies-controls"> <div class="choice-group"> <ul class="bibliographies-action-add radio-group-items"> <li> <input name="bibliography" id="my-bibliography" class="my-bibliography" type="radio" checked/> <label for="my-bibliography">My Bibliography</label> </li> </ul> </div> </div> <div class="bibliographies-retry-load-on-error usa-input-error-message selection-validation-message"> Unable to load your delegates due to an error<br> <a href="#">Please try again</a> </div> <div class="action-panel-actions"> <button class="action-panel-submit" type="submit" data-loading-label="Adding..." data-pinger-ignore> Add </button> <button class="action-panel-cancel" aria-label="Close 'Add to bibliography' panel" ref="linksrc=close_bibliography_panel" aria-controls="bibliography-action-panel" aria-expanded="false" data-ga-category="save_share" data-ga-action="mybib" data-ga-label="cancel"> Cancel </button> </div> </form> </div> </div> <div id="saved-search-action-panel" class="saved-search-action-panel action-panel " aria-hidden="true" data-saved-search-open-panel-enabled="false" data-saved-search-open-panel-url-hash="#open-saved-search-panel"> <div class="inner-wrap"> <h2 class="action-panel-heading"> Your saved search </h2> <form id="saved-search-action-panel-form" class="saved-search-action-panel-form action-panel-content action-form" data-create-saved-search-url="/create-saved-search/" data-try-search-terms-url="/try-search-term/" data-saved-search-root-url="https://www.ncbi.nlm.nih.gov/myncbi/searches/"> <input type="hidden" name="csrfmiddlewaretoken" value="vMszhBsA2vedNsgXnOHJJdXXBKmcOORU4cHIPG4cCGpZ8mbc18r8ONh5CxyPQBWN"> <div class="action-panel-control-wrap"> <label for="saved-search-name" class="action-panel-label saved-search-name-label required-field-asterisk"> Name of saved search: </label> <input maxlength="200" type="text" name="saved-search-name" id="saved-search-name" class="saved-search-name" value="" required pattern="[^"&=<>\/]*" title="The following characters are not allowed in the Name field: "&=<>/"> </div> <div class="action-panel-control-wrap"> <label for="saved-search-term" class="action-panel-label required-field-asterisk"> Search terms: </label> <textarea name="saved-search-term" id="saved-search-term" class="saved-search-term" required></textarea> </div> <div class="test-search-term-wrap"> <a href="#" class="try-search-term">Test search terms</a> </div> <div class="choice-group action-panel-extra-margin-top"> <span class="action-panel-label" id="fieldset-label"> Would you like email updates of new search results? </span> <fieldset id="saved-search-alert" aria-describedby="fieldset-label"> <legend class="usa-sr-only">Saved Search Alert Radio Buttons</legend> <ul class="radio-group-items"> <li> <input type="radio" id="saved-search-alert-yes" class="saved-search-alert-yes" name="saved-search-alert" value="yes" checked> <label for="saved-search-alert-yes" class="action-panel-label">Yes</label> </li> <li> <input aria-label="No radio input" type="radio" id="saved-search-alert-no" class="saved-search-alert-no" name="saved-search-alert" value="no"> <label for="saved-search-alert-no" class="action-panel-label">No</label> </li> </ul> </fieldset> </div> <div class="alert-schedule-wrap"> <div class="action-panel-control-wrap"> <label class="action-panel-label"> Email: </label> <span aria-label="Email address" id="saved-search-email" class="action-panel-label"><span class="action-panel-label-bold"></span> (<a class="myncbi-account-settings" href="https://www.ncbi.nlm.nih.gov/account/settings/">change</a>)</span> </div> <div class="action-panel-control-wrap action-panel-extra-margin-top"> <label for="saved-search-frequency" class="action-panel-label"> Frequency: </label> <select id="saved-search-frequency" class="no-border-panel-selector saved-search-frequency"> <option value="monthly">Monthly</option> <option value="weekly">Weekly</option> <option value="daily">Daily</option> </select> </div> <div class="action-panel-control-wrap saved-search-monthly-additional"> <label for="saved-search-monthly-on-day" class="action-panel-label"> Which day? </label> <select id="saved-search-monthly-on-day" class="no-border-panel-selector"> <option value="Sunday">The first Sunday</option> <option value="Monday">The first Monday</option> <option value="Tuesday">The first Tuesday</option> <option value="Wednesday">The first Wednesday</option> <option value="Thursday">The first Thursday</option> <option value="Friday">The first Friday</option> <option value="Saturday">The first Saturday</option> <option value="day">The first day</option> <option value="weekday">The first weekday</option> </select> </div> <div class="action-panel-control-wrap saved-search-weekly-additional"> <label for="saved-search-weekly-on-day" class="action-panel-label"> Which day? </label> <select id="saved-search-weekly-on-day" class="no-border-panel-selector saved-search-weekly-on-day"> <option value="Sunday">Sunday</option> <option value="Monday">Monday</option> <option value="Tuesday">Tuesday</option> <option value="Wednesday">Wednesday</option> <option value="Thursday">Thursday</option> <option value="Friday">Friday</option> <option value="Saturday">Saturday</option> </select> </div> <div class="action-panel-control-wrap"> <label for="saved-search-report" class="action-panel-label"> Report format: </label> <select id="saved-search-report" class="no-border-panel-selector saved-search-report"> <option value="DocSum">Summary</option> <option value="DocSumText">Summary (text)</option> <option value="Abstract">Abstract</option> <option value="AbstractText">Abstract (text)</option> <option value="MEDLINE">PubMed</option> </select> </div> <div class="action-panel-control-wrap"> <label for="saved-search-amount" class="action-panel-label"> Send at most: </label> <select id="saved-search-amount" class="no-border-panel-selector saved-search-amount"> <option value="1">1 item</option> <option value="5" selected>5 items</option> <option value="10">10 items</option> <option value="20">20 items</option> <option value="50">50 items</option> <option value="100">100 items</option> <option value="200">200 items</option> </select> </div> <div> <input type="checkbox" id="saved-search-send-if-no-result" class="saved-search-send-if-no-result" name="saved-search-send-if-no-result"> <label for="saved-search-send-if-no-result" class="action-panel-label smaller-checkbox"> Send even when there aren't any new results </label> </div> <div class="action-panel-control-wrap option-text-in-email-wrap"> <label for="saved-search-email-text" class="action-panel-label"> Optional text in email: </label> <textarea name="saved-search-email-text" id="saved-search-email-text" class="saved-search-email-text"></textarea> </div> </div> <div class="action-panel-actions"> <button class="action-panel-submit" type="submit" data-loading-label="Saving..." data-ga-category="save_share" data-ga-action="alert" data-ga-label="save"> Save </button> <button class="action-panel-cancel" aria-label="Close 'Your saved search' panel" ref="linksrc=close_saved_search_panel" aria-controls="saved-search-action-panel" aria-expanded="false" data-ga-category="save_share" data-ga-action="alert" data-ga-label="cancel"> Cancel </button> </div> </form> </div> </div> <div id="citation-manager-action-panel" class="citation-manager-action-panel action-panel" aria-hidden="true"> <div class="inner-wrap"> <h2 class="action-panel-heading"> Create a file for external citation management software </h2> <form id="citation-manager-action-panel-form" class="action-panel-content action-form" action="/results-export-ids/" data-by-search-action="/results-export-search-data/" data-by-ids-action="/results-export-ids/" method="post" data-by-search-method="post" data-by-ids-method="post"> <input type="hidden" name="csrfmiddlewaretoken" value="vMszhBsA2vedNsgXnOHJJdXXBKmcOORU4cHIPG4cCGpZ8mbc18r8ONh5CxyPQBWN"> <input name="results-format" type="hidden" value="pubmed"/> <div class="action-panel-actions"> <button class="action-panel-submit" type="submit" data-loading-label="Sending..." data-ga-category="save_share" data-ga-action="citation_manager" data-ga-label="save"> Create file </button> <button class="action-panel-cancel" aria-label="Close 'Send citations to citation manager' panel" ref="linksrc=close_citation_manager_panel" aria-controls="citation-manager-action-panel" aria-expanded="false" data-ga-category="save_share" data-ga-action="citation_manager" data-ga-label="cancel"> Cancel </button> </div> </form> </div> </div> <div id="rss-action-panel" class="rss-action-panel action-panel " aria-hidden="true"> <div class="inner-wrap"> <h2 class="action-panel-heading"> Your RSS Feed </h2> <form id="rss-action-panel-form" class="rss-action-panel-form action-panel-content action-form" data-create-rss-feed-url="/create-rss-feed-url/" data-search-form-term-value=""> <input type="hidden" name="csrfmiddlewaretoken" value="vMszhBsA2vedNsgXnOHJJdXXBKmcOORU4cHIPG4cCGpZ8mbc18r8ONh5CxyPQBWN"> <div class="action-panel-control-wrap"> <label for="rss-name" class="action-panel-label required-field-asterisk"> Name of RSS Feed: </label> <input maxlength="200" placeholder="Name" type="text" name="rss-name" id="rss-name" class="rss-name" value='' required pattern="[^"&=<>\/]*" title="The following characters are not allowed in the Name field: "&=<>/"> </div> <div class="rss-limit-wrap"> <div class="action-panel-control-wrap action-panel-extra-margin-top"> <label for="rss-limit" class="action-panel-label"> Number of items displayed: </label> <select id="rss-limit" class="no-border-panel-selector rss-limit"> <option value="5">5</option> <option value="10">10</option> <option value="15" selected="selected">15</option> <option value="20">20</option> <option value="50">50</option> <option value="100">100</option> </select> </div> </div> <div class="action-panel-actions"> <button class="action-panel-submit" type="submit" data-loading-label="Creating..." data-ga-category="save_share" data-ga-action="alert" data-ga-label="save"> Create RSS </button> <button class="action-panel-cancel" aria-label="Close 'Your RSS' panel" ref="linksrc=close_rss_panel" aria-controls="rss-action-panel" aria-expanded="false" data-ga-category="save_share" data-ga-action="alert" data-ga-label="cancel"> Cancel </button> </div> <div class="action-panel-control-wrap rss-link-copy-wrap"> <label for="rss-link" class="usa-sr-only">RSS Link</label> <input placeholder="Your RSS Feed Link" type="text" name="rss-link" id="rss-link" class="rss-link" title="RSS Link"> <button type="button" disabled class="rss-link-copy-button disabled" data-ga-category="save_share" data-ga-action="rss" data-ga-label="copy"> Copy </button> </div> </form> </div> </div> </div> </div> <div class="article-page" id="article-page" data-article-pmid="27244102"> <aside class="page-sidebar"> <div class="inner-wrap"> <div class="full-text-links"> <div class="full-view"> <h3 class="title"> Full text links </h3> <div class="full-text-links-list"> <a class="link-item dialog-focus" 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value="vMszhBsA2vedNsgXnOHJJdXXBKmcOORU4cHIPG4cCGpZ8mbc18r8ONh5CxyPQBWN"><div class="choice-group" role="radiogroup"><ul class="radio-group-items"><li><input type="radio" id="collections-action-dialog-new" class="collections-new" name="collections" value="new" data-ga-category="collections_button" data-ga-action="click" data-ga-label="collections_radio_new"><label for="collections-action-dialog-new">Create a new collection</label></li><li><input type="radio" id="collections-action-dialog-existing" class="collections-existing" name="collections" value="existing" checked="true" data-ga-category="collections_button" data-ga-action="click" data-ga-label="collections_radio_existing"><label for="collections-action-dialog-existing">Add to an existing collection</label></li></ul></div><div class="controls-wrapper"><div class="action-panel-control-wrap new-collections-controls"><label for="collections-action-dialog-add-to-new" class="action-panel-label required-field-asterisk"> Name your collection: </label><input type="text" name="add-to-new-collection" id="collections-action-dialog-add-to-new" class="collections-action-add-to-new" pattern="[^"&=<>\/]*" title="The following characters are not allowed in the Name field: "&=<>/" maxlength="100" data-ga-category="collections_button" data-ga-action="create_collection" data-ga-label="non_favorties_collection"><div class="collections-new-name-too-long usa-input-error-message selection-validation-message"> Name must be less than 100 characters </div></div><div class="action-panel-control-wrap existing-collections-controls"><label for="collections-action-dialog-add-to-existing" class="action-panel-label"> Choose a collection: </label><select id="collections-action-dialog-add-to-existing" class="action-panel-selector collections-action-add-to-existing" data-ga-category="collections_button" data-ga-action="select_collection" data-ga-label="($('.collections-action-add-to-existing').val() === 'Favorites') ? 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dropdown-block"><button id="full-view-journal-trigger" class="journal-actions-trigger trigger" ref="linksrc=journal_actions_btn" title="Annals of the New York Academy of Sciences" tabindex="0" aria-controls="full-view-journal" aria-expanded="false" aria-label="Toggle dropdown menu for journal Annals of the New York Academy of Sciences" data-pinger-ignore> Ann N Y Acad Sci </button><div id="full-view-journal" class="journal-actions-dropdown dropdown dropdown-container" hidden aria-label="Dropdown menu for journal Annals of the New York Academy of Sciences"><div class="title">Actions</div><div class="content"><ul class="journal-actions-links"><li><a class="search-in-pubmed-link dropdown-block-link" href="/?term=%22Ann+N+Y+Acad+Sci%22%5Bjour%5D&sort=date&sort_order=desc" data-href="/?term=%22Ann+N+Y+Acad+Sci%22%5Bjour%5D&sort=date&sort_order=desc" ref="linksrc=search_in_pubmed_journal_name_link&journal_abbrev=Ann N Y Acad Sci" data-ga-category="search" data-ga-action="journal_link" 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and countermeasures </h1> <div class="inline-authors"> <div class="authors"> <div class="authors-list"> <span class="authors-list-item "><a class="full-name" href="/?term=Feinstein+DL&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Douglas L Feinstein">Douglas L Feinstein</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#full-view-affiliation-1" ref="linksrc=author_aff"> 1 </a><span class="author-sup-separator"> </span><a class="affiliation-link" title="Jesse Brown VA Medical Center, Chicago, Illinois." href="#full-view-affiliation-2" ref="linksrc=author_aff"> 2 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Akpa+BS&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Belinda S Akpa">Belinda S Akpa</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina." href="#full-view-affiliation-3" ref="linksrc=author_aff"> 3 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Ayee+MA&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Manuela A Ayee">Manuela A Ayee</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Medicine, University of Illinois, Chicago, Illinois." href="#full-view-affiliation-4" ref="linksrc=author_aff"> 4 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Boullerne+AI&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Anne I Boullerne">Anne I Boullerne</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#full-view-affiliation-1" ref="linksrc=author_aff"> 1 </a><span class="author-sup-separator"> </span><a class="affiliation-link" title="Jesse Brown VA Medical Center, Chicago, Illinois." href="#full-view-affiliation-2" ref="linksrc=author_aff"> 2 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Braun+D&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="David Braun">David Braun</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#full-view-affiliation-1" ref="linksrc=author_aff"> 1 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Brodsky+SV&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Sergey V Brodsky">Sergey V Brodsky</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Pathology, the Ohio State University, Columbus, Ohio." href="#full-view-affiliation-5" ref="linksrc=author_aff"> 5 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Gidalevitz+D&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="David Gidalevitz">David Gidalevitz</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Physics and the Center for the Molecular Study of Condensed Soft Matter, Illinois Institute of Technology, Chicago, Illinois." href="#full-view-affiliation-6" ref="linksrc=author_aff"> 6 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Hauck+Z&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Zane Hauck">Zane Hauck</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Medicinal Chemistry and Pharmacognosy, University of Illinois, Chicago, Illinois." href="#full-view-affiliation-7" ref="linksrc=author_aff"> 7 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Kalinin+S&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Sergey Kalinin">Sergey Kalinin</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#full-view-affiliation-1" ref="linksrc=author_aff"> 1 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Kowal+K&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Kathy Kowal">Kathy Kowal</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#full-view-affiliation-1" ref="linksrc=author_aff"> 1 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Kuzmenko+I&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Ivan Kuzmenko">Ivan Kuzmenko</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="X-ray Science Division, Argonne National Laboratory, Lemont, Illinois." href="#full-view-affiliation-8" ref="linksrc=author_aff"> 8 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Lis+K&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Kinga Lis">Kinga Lis</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#full-view-affiliation-1" ref="linksrc=author_aff"> 1 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Marangoni+N&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Natalia Marangoni">Natalia Marangoni</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#full-view-affiliation-1" ref="linksrc=author_aff"> 1 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Martynowycz+MW&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Michael W Martynowycz">Michael W Martynowycz</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Physics and the Center for the Molecular Study of Condensed Soft Matter, Illinois Institute of Technology, Chicago, Illinois." href="#full-view-affiliation-6" ref="linksrc=author_aff"> 6 </a><span class="author-sup-separator"> </span><a class="affiliation-link" title="X-ray Science Division, Argonne National Laboratory, Lemont, Illinois." href="#full-view-affiliation-8" ref="linksrc=author_aff"> 8 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Rubinstein+I&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Israel Rubinstein">Israel Rubinstein</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#full-view-affiliation-1" ref="linksrc=author_aff"> 1 </a><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Medicine, University of Illinois, Chicago, Illinois." href="#full-view-affiliation-4" ref="linksrc=author_aff"> 4 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=van+Breemen+R&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Richard van Breemen">Richard van Breemen</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#full-view-affiliation-1" ref="linksrc=author_aff"> 1 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Ware+K&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Kyle Ware">Kyle Ware</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Pathology, the Ohio State University, Columbus, Ohio." href="#full-view-affiliation-5" ref="linksrc=author_aff"> 5 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Weinberg+G&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Guy Weinberg">Guy Weinberg</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#full-view-affiliation-1" ref="linksrc=author_aff"> 1 </a><span class="author-sup-separator"> </span><a class="affiliation-link" title="Jesse Brown VA Medical Center, Chicago, Illinois." href="#full-view-affiliation-2" ref="linksrc=author_aff"> 2 </a></sup></span> </div> </div> </div> <div class="short-article-details"> Affiliations <button class="more-details" id="toggle-authors" data-alt-text="Collapse" 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id="short-view-heading"> <div class="publication-type" >Review</div> <h1 class="heading-title"> The emerging threat of superwarfarins: history, detection, mechanisms, and countermeasures </h1> <div class="short-citation"> <span class="authors-list"> <span class="authors-list-item "><span class="full-name">Douglas L Feinstein</span><span class="citation-separator"> et al.</span></span> </span> <span class="citation-journal"> Ann N Y Acad Sci<span class="citation-separator">.</span> </span> <span class="date"> <span class="citation-year">2016 Jun</span><span class="citation-separator">.</span> </span> </div> <div class="more-article-details-section with-display-settings"> <button class="more-article-details" id="toggle-article-details" data-alt-text="Hide details" ref="linksrc=toggle_article_details" aria-controls="full-article-details" aria-expanded="false" data-fetch-url="/27244102/long-authors/" data-id-prefix=""> <span class="title">Show details</span> </button> <div 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</a></li><li><a class="search-in-nlm-catalog-link dropdown-block-link" ref ="linksrc=search_in_nlm_catalog_link" href="https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Ann+N+Y+Acad+Sci%22%5BTitle+Abbreviation%5D" data-ga-category="search_catalog" data-ga-action="journal_link" data-ga-label="Ann N Y Acad Sci"> Search in NLM Catalog </a></li><li><a class="add-to-search-link dropdown-block-link" ref ="linksrc=add_to_search_link" role="button" data-search-term='"Ann N Y Acad Sci"[jour]' data-ga-category="search" data-ga-action="add_to_search" data-ga-label='"Ann N Y Acad Sci"[jour]' href="#"> Add to Search </a></li></ul></div></div></div><span class="period">. </span><span class="cit">2016 Jun;1374(1):111-22.</span> </div> <span class="citation-doi"> doi: 10.1111/nyas.13085. </span> <span class="secondary-date"> Epub 2016 May 31. </span> </div> <div class="expanded-authors" id="short-view-expanded-authors"> <div class="authors"> <h3 class="title"> Authors </h3> <div class="authors-list"> <span class="authors-list-item "><a class="full-name" href="/?term=Feinstein+DL&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Douglas L Feinstein">Douglas L Feinstein</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#short-view-affiliation-1" ref="linksrc=author_aff"> 1 </a><span class="author-sup-separator"> </span><a class="affiliation-link" title="Jesse Brown VA Medical Center, Chicago, Illinois." href="#short-view-affiliation-2" ref="linksrc=author_aff"> 2 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Akpa+BS&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Belinda S Akpa">Belinda S Akpa</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina." href="#short-view-affiliation-3" ref="linksrc=author_aff"> 3 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Ayee+MA&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Manuela A Ayee">Manuela A Ayee</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Medicine, University of Illinois, Chicago, Illinois." href="#short-view-affiliation-4" ref="linksrc=author_aff"> 4 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Boullerne+AI&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Anne I Boullerne">Anne I Boullerne</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#short-view-affiliation-1" ref="linksrc=author_aff"> 1 </a><span class="author-sup-separator"> </span><a class="affiliation-link" title="Jesse Brown VA Medical Center, Chicago, Illinois." href="#short-view-affiliation-2" ref="linksrc=author_aff"> 2 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Braun+D&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="David Braun">David Braun</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#short-view-affiliation-1" ref="linksrc=author_aff"> 1 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Brodsky+SV&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Sergey V Brodsky">Sergey V Brodsky</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Pathology, the Ohio State University, Columbus, Ohio." href="#short-view-affiliation-5" ref="linksrc=author_aff"> 5 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Gidalevitz+D&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="David Gidalevitz">David Gidalevitz</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Physics and the Center for the Molecular Study of Condensed Soft Matter, Illinois Institute of Technology, Chicago, Illinois." href="#short-view-affiliation-6" ref="linksrc=author_aff"> 6 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Hauck+Z&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Zane Hauck">Zane Hauck</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Medicinal Chemistry and Pharmacognosy, University of Illinois, Chicago, Illinois." href="#short-view-affiliation-7" ref="linksrc=author_aff"> 7 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Kalinin+S&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Sergey Kalinin">Sergey Kalinin</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#short-view-affiliation-1" ref="linksrc=author_aff"> 1 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Kowal+K&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Kathy Kowal">Kathy Kowal</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#short-view-affiliation-1" ref="linksrc=author_aff"> 1 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Kuzmenko+I&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Ivan Kuzmenko">Ivan Kuzmenko</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="X-ray Science Division, Argonne National Laboratory, Lemont, Illinois." href="#short-view-affiliation-8" ref="linksrc=author_aff"> 8 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Lis+K&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Kinga Lis">Kinga Lis</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#short-view-affiliation-1" ref="linksrc=author_aff"> 1 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Marangoni+N&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Natalia Marangoni">Natalia Marangoni</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#short-view-affiliation-1" ref="linksrc=author_aff"> 1 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Martynowycz+MW&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Michael W Martynowycz">Michael W Martynowycz</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Physics and the Center for the Molecular Study of Condensed Soft Matter, Illinois Institute of Technology, Chicago, Illinois." href="#short-view-affiliation-6" ref="linksrc=author_aff"> 6 </a><span class="author-sup-separator"> </span><a class="affiliation-link" title="X-ray Science Division, Argonne National Laboratory, Lemont, Illinois." href="#short-view-affiliation-8" ref="linksrc=author_aff"> 8 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Rubinstein+I&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Israel Rubinstein">Israel Rubinstein</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#short-view-affiliation-1" ref="linksrc=author_aff"> 1 </a><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Medicine, University of Illinois, Chicago, Illinois." href="#short-view-affiliation-4" ref="linksrc=author_aff"> 4 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=van+Breemen+R&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Richard van Breemen">Richard van Breemen</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#short-view-affiliation-1" ref="linksrc=author_aff"> 1 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Ware+K&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Kyle Ware">Kyle Ware</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Pathology, the Ohio State University, Columbus, Ohio." href="#short-view-affiliation-5" ref="linksrc=author_aff"> 5 </a></sup><span class="comma">, </span></span><span class="authors-list-item "><a class="full-name" href="/?term=Weinberg+G&cauthor_id=27244102" ref="linksrc=author_name_link" data-ga-category="search" data-ga-action="author_link" data-ga-label="Guy Weinberg">Guy Weinberg</a><sup class="affiliation-links"><span class="author-sup-separator"> </span><a class="affiliation-link" title="Department of Anesthesiology, University of Illinois, Chicago, Illinois." href="#short-view-affiliation-1" ref="linksrc=author_aff"> 1 </a><span class="author-sup-separator"> </span><a class="affiliation-link" title="Jesse Brown VA Medical Center, Chicago, Illinois." href="#short-view-affiliation-2" ref="linksrc=author_aff"> 2 </a></sup></span> </div> </div> <div class="affiliations"> <h3 class="title"> Affiliations </h3> <ul class="item-list"> <li data-affiliation-id="short-view-affiliation-1" id="short-view-affiliation-1" ><sup class="key">1</sup> Department of Anesthesiology, University of Illinois, Chicago, Illinois.</li> <li data-affiliation-id="short-view-affiliation-2" id="short-view-affiliation-2" ><sup class="key">2</sup> Jesse Brown VA Medical Center, Chicago, Illinois.</li> <li data-affiliation-id="short-view-affiliation-3" id="short-view-affiliation-3" ><sup class="key">3</sup> Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina.</li> <li data-affiliation-id="short-view-affiliation-4" id="short-view-affiliation-4" ><sup class="key">4</sup> Department of Medicine, University of Illinois, Chicago, Illinois.</li> <li data-affiliation-id="short-view-affiliation-5" id="short-view-affiliation-5" ><sup class="key">5</sup> Department of Pathology, the Ohio State University, Columbus, Ohio.</li> <li data-affiliation-id="short-view-affiliation-6" id="short-view-affiliation-6" ><sup class="key">6</sup> Department of Physics and the Center for the Molecular Study of Condensed Soft Matter, Illinois Institute of Technology, Chicago, Illinois.</li> <li data-affiliation-id="short-view-affiliation-7" id="short-view-affiliation-7" ><sup class="key">7</sup> Department of Medicinal Chemistry and Pharmacognosy, University of Illinois, Chicago, Illinois.</li> <li data-affiliation-id="short-view-affiliation-8" id="short-view-affiliation-8" ><sup class="key">8</sup> X-ray Science Division, Argonne National Laboratory, Lemont, Illinois.</li> </ul> </div> </div> <ul class="identifiers" id="short-view-identifiers"> <li> <span class="identifier pubmed"> <span class="id-label"> PMID: </span> <strong class="current-id" title="PubMed ID">27244102</strong> </span> </li> <li> <span class="identifier pmc"> <span class="id-label"> PMCID: </span> <a class="id-link" target="_blank" rel="noopener" ref="linksrc=article_id_link&article_id=PMC4940222&id_type=PMC" href="https://pmc.ncbi.nlm.nih.gov/articles/PMC4940222/" data-ga-category="full_text" data-ga-action="PMCID" > PMC4940222 </a> </span> </li> <li> <span class="identifier doi"> <span class="id-label"> DOI: </span> <a class="id-link" target="_blank" rel="noopener" ref="linksrc=article_id_link&article_id=10.1111/nyas.13085&id_type=DOI" href="https://doi.org/10.1111/nyas.13085" data-ga-category="full_text" data-ga-action="DOI" > 10.1111/nyas.13085 </a> </span> </li> </ul> <div class="in-clipboard-label " hidden> Item in Clipboard </div> </div> </div> </header> <div class="actions-buttons inline"><div class="inner-wrap"><button class="full-text-links-button full-text-links-dialog-trigger" title="Open dialog with full text links" ref="linksrc=full_text_links"> Full text links </button><button class="citation-button citation-dialog-trigger" aria-label="Open dialog with citation text in different styles" data-ga-category="save_share" data-ga-action="cite" data-ga-label="open" data-all-citations-url="/27244102/citations/" data-citation-style="nlm" data-pubmed-format-link="/27244102/export/"><span class="button-label">Cite</span></button><button class="more-actions-button more-actions-dialog-trigger" title="Open dialog with more actions to take" ref="linksrc=more_actions_btn"></button><div class="display-options" data-format-key="format" data-default-format-value="abstract" data-current-format-value="abstract" role="region"><button class="trigger usa-button" title="Change format" data-ga-category="display_options" data-ga-action="display_options_dialog"><span class="button-label">Display options</span></button><div class="dropdown" hidden><div class="title"> Display options </div><div class="content"><div class="format-container"><span class="option-label"> Format </span><select name="format" data-initial-value="abstract" aria-label="Display format" id="inline-actions-display-format"><option value="abstract">Abstract</option><option value="pubmed">PubMed</option><option value="pmid">PMID</option></select></div></div></div></div></div></div> <div class="abstract" id="abstract"> <h2 class="title"> Abstract </h2> <div class="abstract-content selected" id="eng-abstract"> <p> Superwarfarins were developed following the emergence of warfarin resistance in rodents. Compared to warfarin, superwarfarins have much longer half-lives and stronger affinity to vitamin K epoxide reductase and therefore can cause death in warfarin-resistant rodents. By the mid-1970s, the superwarfarins brodifacoum and difenacoum were the most widely used rodenticides throughout the world. Unfortunately, increased use was accompanied by a rise in accidental poisonings, reaching >16,000 per year in the United States. Risk of exposure has become a concern since large quantities, up to hundreds of kilograms of rodent bait, are applied by aerial dispersion over regions with rodent infestations. Reports of intentional use of superwarfarins in civilian and military scenarios raise the specter of larger incidents or mass casualties. Unlike warfarin overdose, for which 1-2 days of treatment with vitamin K is effective, treatment of superwarfarin poisoning with vitamin K is limited by extremely high cost and can require daily treatment for a year or longer. Furthermore, superwarfarins have actions that are independent of their anticoagulant effects, including both vitamin K-dependent and -independent effects, which are not mitigated by vitamin K therapy. In this review, we summarize superwarfarin development, biology and pathophysiology, their threat as weapons, and possible therapeutic approaches. </p> </div> <p> <strong class="sub-title"> Keywords: </strong> HPLC; brodifacoum; intralipid; lipid membrane; nephrotoxicity; neuropathology; superwarfarins. </p> </div> <p class="copyright" id="copyright"> © 2016 New York Academy of Sciences. </p> <p class="disclaimer" id="disclaimer"> <a href="/disclaimer/" target="_blank" ga_category="literature_resources" ga_action="disclaimer_link" ga_label="under_abstract">PubMed Disclaimer</a> </p> <div class="conflict-of-interest" id="conflict-of-interest"> <h2 class="title"> Conflict of interest statement </h2> <div class="statement"> <p xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:p1="http://pubmed.gov/pub-one"><bold>Conflicts of interest</bold></p> <p xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:p1="http://pubmed.gov/pub-one">The authors declare no conflicts of interest.</p> </div> </div> <div class="figures" id="figures"> <h2 class="title"> Figures </h2> <div class="figures-list" id="slides-container" itemscope itemtype="http://schema.org/ImageGallery"> <figure class="figure-item " itemscope itemtype="http://schema.org/ImageObject" itemprop="associatedMedia" data-slide-index="0" data-label-slug="figure-1"> <a class="figure-link" href="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec83/4940222/b031bcc76d4a/nihms777312f1.jpg" itemprop="contentUrl" aria-describedby="figure-caption-0" role="button" data-image-width="604" data-image-height="354" data-image-alt="Figure 1" data-pmc-id="PMC4940222" data-figure-id="F1"> <img class="figure-thumb" itemprop="thumbnail" id="article-image-0" src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec83/4940222/5cbc4a8a8092/nihms777312f1.gif" alt="Figure 1" /> </a> <meta itemprop="width" itemtype="http://schema.org/ImageObject" content="604"> <meta itemprop="height" itemtype="http://schema.org/ImageObject" content="354"> <div class="figure-caption figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="caption" aria-hidden="true"> <div class="caption-wrap"> <strong class="figure-label"> <p> Figure 1 </p> </strong> <div class="figure-caption-contents"><p> Chemical structures: (i) dicoumarol; (ii)… </p></div> </div> </div> <div class="figure-caption-medium figure-caption-text" aria-hidden="true"> <strong class="figure-label"> <p> Figure 1 </p> </strong> <div class="figure-caption-contents"><p> Chemical structures: (i) dicoumarol; (ii) coumarin; (iii) warfarin; (iv) difenacoum; (v) brodifacoum. *… </p></div> </div> <figcaption id="figure-caption-0" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description"> <strong class="figure-label"> Figure 1 </strong> <div class="figure-caption-contents">Chemical structures: (i) dicoumarol; (ii) coumarin; (iii) warfarin; (iv) difenacoum; (v) brodifacoum. * indicates the two chiral centers in BDF and DiF, which lead to four enantiomers.</div> </figcaption> </figure> <figure class="figure-item " itemscope itemtype="http://schema.org/ImageObject" itemprop="associatedMedia" data-slide-index="1" data-label-slug="figure-2"> <a class="figure-link" href="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec83/4940222/b932eb5c85c3/nihms777312f2.jpg" itemprop="contentUrl" aria-describedby="figure-caption-1" role="button" data-image-width="645" data-image-height="337" data-image-alt="Figure 2" data-pmc-id="PMC4940222" data-figure-id="F2"> <img class="figure-thumb" itemprop="thumbnail" id="article-image-1" src="https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec83/4940222/6d18a8249f00/nihms777312f2.gif" alt="Figure 2" /> </a> <meta itemprop="width" itemtype="http://schema.org/ImageObject" content="645"> <meta itemprop="height" itemtype="http://schema.org/ImageObject" content="337"> <div class="figure-caption figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="caption" aria-hidden="true"> <div class="caption-wrap"> <strong class="figure-label"> <p> Figure 2 </p> </strong> <div class="figure-caption-contents"><p> Molecular simulations of BDF interaction… </p></div> </div> </div> <div class="figure-caption-medium figure-caption-text" aria-hidden="true"> <strong class="figure-label"> <p> Figure 2 </p> </strong> <div class="figure-caption-contents"><p> Molecular simulations of BDF interaction with DPPC membranes. (A) The bolaamphiphilic character of… </p></div> </div> <figcaption id="figure-caption-1" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description"> <strong class="figure-label"> Figure 2 </strong> <div class="figure-caption-contents">Molecular simulations of BDF interaction with DPPC membranes. (A) The bolaamphiphilic character of brodifacoum allows the compound to adopt both extended (intercalated) and u-shaped conformations at the air–water interface. Depicted are three different BDF molecules coabsorbed at the interface. The region occupied by the polar head group and glycerol backbone of DPPC is rendered in yellow, and the hydrophobic tail region in orange. Water is rendered in blue. (B) The bolamphiphilic nature of BDF is predicted to facilitate water permeation of a DPPC bilayer. Water molecules are depicted as blue spheres. Modified from Ref. .</div> </figcaption> </figure> </div>  <div class="pswp figures-dialog" id="figures-dialog" tabindex="-1" role="dialog" aria-hidden="true" data-image-gallery-uid="article-figures" aria-label="Figures Dialog">  <div class="pswp__bg"></div>  <div class="pswp__scroll-wrap">  <div class="pswp__container"> <div class="pswp__item"></div> <div class="pswp__item"></div> <div class="pswp__item"></div> </div>  <div class="pswp__ui pswp__ui--hidden"> <div class="pswp__top-bar">  <div class="pswp__counter"></div> <button class="pswp__button pswp__button--close" title="Close (Esc)"></button> <button class="pswp__button pswp__button--share" title="Share"></button> <button class="pswp__button pswp__button--fs" title="Toggle fullscreen"></button> <button class="pswp__button pswp__button--zoom" title="Zoom in/out"></button>   <div class="pswp__preloader"> <div class="pswp__preloader__icn"> <div class="pswp__preloader__cut"> <div class="pswp__preloader__donut"></div> </div> </div> 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class="add-to-search-link dropdown-block-link" ref="linksrc=add_to_search_link" role="button" data-search-term=""Anticoagulants/chemistry"[MeSH]" data-ga-category="search" data-ga-action="add_to_search" data-ga-label=""Anticoagulants/chemistry"[MeSH]" href="#"> Add to Search </a></li></ul></div></div></div></li><li><div class="keyword-actions dropdown-block"><button class="keyword-actions-trigger trigger keyword-link" aria-label="Toggle dropdown menu for keyword Biomarkers / analysis" tabindex="0" aria-controls="keyword-actions-mesh-terms-4" aria-expanded="false" data-pinger-ignore> Biomarkers / analysis </button><div id="keyword-actions-mesh-terms-4" class="keyword-actions-dropdown dropdown dropdown-container" hidden aria-label="Dropdown menu for keyword Biomarkers / analysis"><div class="title">Actions</div><div class="content"><ul class="keyword-actions-links"><li><a class="search-in-pubmed-link dropdown-block-link" href="/?term=%22Biomarkers%2Fanalysis%22%5BMeSH%5D&sort=date&sort_order=desc" data-href="/?term=%22Biomarkers%2Fanalysis%22%5BMeSH%5D&sort=date&sort_order=desc" ref="linksrc=search_in_pubmed_keyword_link&mesh="Biomarkers/analysis"[MeSH]" data-ga-category="search" data-ga-action="mesh_term" data-ga-label="Biomarkers / analysis"> Search in PubMed </a></li><li><a class="search-in-mesh-link dropdown-block-link" ref="linksrc=search_in_mesh_link" href="https://www.ncbi.nlm.nih.gov/mesh?term=Biomarkers" data-ga-category="search_mesh" data-ga-action="mesh_term_link" data-ga-label="Biomarkers / analysis"> Search in MeSH </a></li><li><a class="add-to-search-link dropdown-block-link" ref="linksrc=add_to_search_link" role="button" data-search-term=""Biomarkers/analysis"[MeSH]" data-ga-category="search" data-ga-action="add_to_search" data-ga-label=""Biomarkers/analysis"[MeSH]" href="#"> Add to Search </a></li></ul></div></div></div></li><li><div class="keyword-actions dropdown-block"><button class="keyword-actions-trigger trigger keyword-link" aria-label="Toggle dropdown menu for keyword Environmental Exposure / analysis" tabindex="0" aria-controls="keyword-actions-mesh-terms-5" aria-expanded="false" data-pinger-ignore> Environmental Exposure / analysis </button><div id="keyword-actions-mesh-terms-5" class="keyword-actions-dropdown dropdown dropdown-container" hidden aria-label="Dropdown menu for keyword Environmental Exposure / analysis"><div class="title">Actions</div><div class="content"><ul class="keyword-actions-links"><li><a class="search-in-pubmed-link dropdown-block-link" href="/?term=%22Environmental+Exposure%2Fanalysis%22%5BMeSH%5D&sort=date&sort_order=desc" data-href="/?term=%22Environmental+Exposure%2Fanalysis%22%5BMeSH%5D&sort=date&sort_order=desc" ref="linksrc=search_in_pubmed_keyword_link&mesh="Environmental Exposure/analysis"[MeSH]" data-ga-category="search" data-ga-action="mesh_term" data-ga-label="Environmental Exposure / analysis"> Search in PubMed 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Add to Search </a></li></ul></div></div></div></li><li><div class="keyword-actions dropdown-block"><button class="keyword-actions-trigger trigger keyword-link" aria-label="Toggle dropdown menu for keyword Kidney / drug effects" tabindex="0" aria-controls="keyword-actions-mesh-terms-7" aria-expanded="false" data-pinger-ignore> Kidney / drug effects </button><div id="keyword-actions-mesh-terms-7" class="keyword-actions-dropdown dropdown dropdown-container" hidden aria-label="Dropdown menu for keyword Kidney / drug effects"><div class="title">Actions</div><div class="content"><ul class="keyword-actions-links"><li><a class="search-in-pubmed-link dropdown-block-link" href="/?term=%22Kidney%2Fdrug+effects%22%5BMeSH%5D&sort=date&sort_order=desc" data-href="/?term=%22Kidney%2Fdrug+effects%22%5BMeSH%5D&sort=date&sort_order=desc" ref="linksrc=search_in_pubmed_keyword_link&mesh="Kidney/drug effects"[MeSH]" data-ga-category="search" data-ga-action="mesh_term" data-ga-label="Kidney / drug effects"> 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dropdown-container" hidden aria-label="Dropdown menu for keyword Kidney / pathology"><div class="title">Actions</div><div class="content"><ul class="keyword-actions-links"><li><a class="search-in-pubmed-link dropdown-block-link" href="/?term=%22Kidney%2Fpathology%22%5BMeSH%5D&sort=date&sort_order=desc" data-href="/?term=%22Kidney%2Fpathology%22%5BMeSH%5D&sort=date&sort_order=desc" ref="linksrc=search_in_pubmed_keyword_link&mesh="Kidney/pathology"[MeSH]" data-ga-category="search" data-ga-action="mesh_term" data-ga-label="Kidney / pathology"> Search in PubMed </a></li><li><a class="search-in-mesh-link dropdown-block-link" ref="linksrc=search_in_mesh_link" href="https://www.ncbi.nlm.nih.gov/mesh?term=Kidney" data-ga-category="search_mesh" data-ga-action="mesh_term_link" data-ga-label="Kidney / pathology"> Search in MeSH </a></li><li><a class="add-to-search-link dropdown-block-link" ref="linksrc=add_to_search_link" role="button" data-search-term=""Kidney/pathology"[MeSH]" data-ga-category="search" data-ga-action="add_to_search" data-ga-label=""Kidney/pathology"[MeSH]" href="#"> Add to Search </a></li></ul></div></div></div></li><li><div class="keyword-actions dropdown-block"><button class="keyword-actions-trigger trigger keyword-link" aria-label="Toggle dropdown menu for keyword Nervous System / drug effects" tabindex="0" aria-controls="keyword-actions-mesh-terms-9" aria-expanded="false" data-pinger-ignore> Nervous System / drug effects </button><div id="keyword-actions-mesh-terms-9" class="keyword-actions-dropdown dropdown dropdown-container" hidden aria-label="Dropdown menu for keyword Nervous System / drug effects"><div class="title">Actions</div><div class="content"><ul class="keyword-actions-links"><li><a class="search-in-pubmed-link dropdown-block-link" href="/?term=%22Nervous+System%2Fdrug+effects%22%5BMeSH%5D&sort=date&sort_order=desc" data-href="/?term=%22Nervous+System%2Fdrug+effects%22%5BMeSH%5D&sort=date&sort_order=desc" ref="linksrc=search_in_pubmed_keyword_link&mesh="Nervous System/drug effects"[MeSH]" data-ga-category="search" data-ga-action="mesh_term" data-ga-label="Nervous System / drug effects"> Search in PubMed </a></li><li><a class="search-in-mesh-link dropdown-block-link" ref="linksrc=search_in_mesh_link" href="https://www.ncbi.nlm.nih.gov/mesh?term=Nervous+System" data-ga-category="search_mesh" data-ga-action="mesh_term_link" data-ga-label="Nervous System / drug effects"> Search in MeSH </a></li><li><a class="add-to-search-link dropdown-block-link" ref="linksrc=add_to_search_link" role="button" data-search-term=""Nervous System/drug effects"[MeSH]" data-ga-category="search" data-ga-action="add_to_search" data-ga-label=""Nervous System/drug effects"[MeSH]" href="#"> Add to Search </a></li></ul></div></div></div></li><li><div class="keyword-actions dropdown-block"><button class="keyword-actions-trigger trigger keyword-link" aria-label="Toggle dropdown menu for keyword Nervous System / pathology" tabindex="0" aria-controls="keyword-actions-mesh-terms-10" aria-expanded="false" data-pinger-ignore> Nervous System / pathology </button><div id="keyword-actions-mesh-terms-10" class="keyword-actions-dropdown dropdown dropdown-container" hidden aria-label="Dropdown menu for keyword Nervous System / pathology"><div class="title">Actions</div><div class="content"><ul class="keyword-actions-links"><li><a class="search-in-pubmed-link dropdown-block-link" href="/?term=%22Nervous+System%2Fpathology%22%5BMeSH%5D&sort=date&sort_order=desc" data-href="/?term=%22Nervous+System%2Fpathology%22%5BMeSH%5D&sort=date&sort_order=desc" ref="linksrc=search_in_pubmed_keyword_link&mesh="Nervous System/pathology"[MeSH]" data-ga-category="search" data-ga-action="mesh_term" data-ga-label="Nervous System / pathology"> Search in PubMed </a></li><li><a class="search-in-mesh-link dropdown-block-link" ref="linksrc=search_in_mesh_link" href="https://www.ncbi.nlm.nih.gov/mesh?term=Nervous+System" data-ga-category="search_mesh" data-ga-action="mesh_term_link" data-ga-label="Nervous System / pathology"> Search in MeSH </a></li><li><a class="add-to-search-link dropdown-block-link" ref="linksrc=add_to_search_link" role="button" data-search-term=""Nervous System/pathology"[MeSH]" data-ga-category="search" data-ga-action="add_to_search" data-ga-label=""Nervous System/pathology"[MeSH]" href="#"> Add to Search </a></li></ul></div></div></div></li><li><div class="keyword-actions dropdown-block"><button class="keyword-actions-trigger trigger keyword-link major" aria-label="Toggle dropdown menu for keyword Warfarin / adverse effects*" tabindex="0" aria-controls="keyword-actions-mesh-terms-major-11" aria-expanded="false" data-pinger-ignore> Warfarin / adverse effects* </button><div id="keyword-actions-mesh-terms-major-11" class="keyword-actions-dropdown dropdown dropdown-container" hidden aria-label="Dropdown menu for keyword Warfarin / adverse effects*"><div class="title">Actions</div><div class="content"><ul class="keyword-actions-links"><li><a class="search-in-pubmed-link dropdown-block-link" href="/?term=%22Warfarin%2Fadverse+effects%22%5BMAJR%5D&sort=date&sort_order=desc" data-href="/?term=%22Warfarin%2Fadverse+effects%22%5BMAJR%5D&sort=date&sort_order=desc" ref="linksrc=search_in_pubmed_keyword_link&mesh="Warfarin/adverse effects"[MAJR]" data-ga-category="search" data-ga-action="mesh_term" data-ga-label="Warfarin / adverse effects*"> Search in PubMed </a></li><li><a class="search-in-mesh-link dropdown-block-link" ref="linksrc=search_in_mesh_link" href="https://www.ncbi.nlm.nih.gov/mesh?term=Warfarin" data-ga-category="search_mesh" data-ga-action="mesh_term_link" data-ga-label="Warfarin / adverse effects*"> Search in MeSH </a></li><li><a class="add-to-search-link dropdown-block-link" ref="linksrc=add_to_search_link" role="button" data-search-term=""Warfarin/adverse effects"[MAJR]" data-ga-category="search" data-ga-action="add_to_search" data-ga-label=""Warfarin/adverse effects"[MAJR]" href="#"> Add to Search </a></li></ul></div></div></div></li><li><div class="keyword-actions dropdown-block"><button class="keyword-actions-trigger trigger keyword-link major" aria-label="Toggle dropdown menu for keyword Warfarin / analysis*" tabindex="0" aria-controls="keyword-actions-mesh-terms-major-12" aria-expanded="false" data-pinger-ignore> Warfarin / analysis* </button><div id="keyword-actions-mesh-terms-major-12" class="keyword-actions-dropdown dropdown dropdown-container" hidden aria-label="Dropdown menu for keyword Warfarin / analysis*"><div class="title">Actions</div><div class="content"><ul class="keyword-actions-links"><li><a class="search-in-pubmed-link dropdown-block-link" href="/?term=%22Warfarin%2Fanalysis%22%5BMAJR%5D&sort=date&sort_order=desc" data-href="/?term=%22Warfarin%2Fanalysis%22%5BMAJR%5D&sort=date&sort_order=desc" ref="linksrc=search_in_pubmed_keyword_link&mesh="Warfarin/analysis"[MAJR]" data-ga-category="search" data-ga-action="mesh_term" data-ga-label="Warfarin / analysis*"> Search in PubMed </a></li><li><a class="search-in-mesh-link dropdown-block-link" ref="linksrc=search_in_mesh_link" href="https://www.ncbi.nlm.nih.gov/mesh?term=Warfarin" data-ga-category="search_mesh" data-ga-action="mesh_term_link" data-ga-label="Warfarin / analysis*"> Search in MeSH </a></li><li><a class="add-to-search-link dropdown-block-link" ref="linksrc=add_to_search_link" role="button" data-search-term=""Warfarin/analysis"[MAJR]" data-ga-category="search" data-ga-action="add_to_search" data-ga-label=""Warfarin/analysis"[MAJR]" href="#"> Add to Search </a></li></ul></div></div></div></li><li><div class="keyword-actions dropdown-block"><button class="keyword-actions-trigger trigger keyword-link" aria-label="Toggle dropdown menu for keyword Warfarin / chemistry" tabindex="0" aria-controls="keyword-actions-mesh-terms-13" aria-expanded="false" data-pinger-ignore> Warfarin / chemistry </button><div id="keyword-actions-mesh-terms-13" class="keyword-actions-dropdown dropdown dropdown-container" hidden aria-label="Dropdown menu for keyword Warfarin / chemistry"><div class="title">Actions</div><div class="content"><ul class="keyword-actions-links"><li><a class="search-in-pubmed-link dropdown-block-link" href="/?term=%22Warfarin%2Fchemistry%22%5BMeSH%5D&sort=date&sort_order=desc" data-href="/?term=%22Warfarin%2Fchemistry%22%5BMeSH%5D&sort=date&sort_order=desc" ref="linksrc=search_in_pubmed_keyword_link&mesh="Warfarin/chemistry"[MeSH]" data-ga-category="search" data-ga-action="mesh_term" data-ga-label="Warfarin / chemistry"> Search in PubMed </a></li><li><a class="search-in-mesh-link dropdown-block-link" ref="linksrc=search_in_mesh_link" href="https://www.ncbi.nlm.nih.gov/mesh?term=Warfarin" data-ga-category="search_mesh" data-ga-action="mesh_term_link" data-ga-label="Warfarin / chemistry"> Search in MeSH </a></li><li><a class="add-to-search-link dropdown-block-link" ref="linksrc=add_to_search_link" role="button" data-search-term=""Warfarin/chemistry"[MeSH]" data-ga-category="search" data-ga-action="add_to_search" data-ga-label=""Warfarin/chemistry"[MeSH]" href="#"> Add to Search </a></li></ul></div></div></div></li><li><div class="keyword-actions dropdown-block"><button class="keyword-actions-trigger trigger keyword-link" aria-label="Toggle dropdown menu for keyword Warfarin / poisoning" tabindex="0" aria-controls="keyword-actions-mesh-terms-14" aria-expanded="false" data-pinger-ignore> Warfarin / poisoning </button><div id="keyword-actions-mesh-terms-14" class="keyword-actions-dropdown dropdown dropdown-container" hidden aria-label="Dropdown menu for keyword Warfarin / poisoning"><div class="title">Actions</div><div class="content"><ul class="keyword-actions-links"><li><a class="search-in-pubmed-link dropdown-block-link" href="/?term=%22Warfarin%2Fpoisoning%22%5BMeSH%5D&sort=date&sort_order=desc" data-href="/?term=%22Warfarin%2Fpoisoning%22%5BMeSH%5D&sort=date&sort_order=desc" ref="linksrc=search_in_pubmed_keyword_link&mesh="Warfarin/poisoning"[MeSH]" data-ga-category="search" data-ga-action="mesh_term" data-ga-label="Warfarin / poisoning"> Search in PubMed </a></li><li><a class="search-in-mesh-link dropdown-block-link" ref="linksrc=search_in_mesh_link" href="https://www.ncbi.nlm.nih.gov/mesh?term=Warfarin" data-ga-category="search_mesh" data-ga-action="mesh_term_link" data-ga-label="Warfarin / poisoning"> Search in MeSH </a></li><li><a class="add-to-search-link dropdown-block-link" ref="linksrc=add_to_search_link" role="button" data-search-term=""Warfarin/poisoning"[MeSH]" data-ga-category="search" data-ga-action="add_to_search" data-ga-label=""Warfarin/poisoning"[MeSH]" href="#"> Add to Search </a></li></ul></div></div></div></li></ul> </div> <div id="substances" class="substances keywords-section"> <h2 class="title"> Substances </h2> <ul class="keywords-list"><li><div class="keyword-actions dropdown-block"><button class="keyword-actions-trigger trigger keyword-link" aria-label="Toggle dropdown menu for keyword Anticoagulants" tabindex="0" aria-controls="keyword-actions-substances-0" aria-expanded="false" data-pinger-ignore> Anticoagulants </button><div id="keyword-actions-substances-0" class="keyword-actions-dropdown dropdown dropdown-container" hidden aria-label="Dropdown menu for keyword Anticoagulants"><div class="title">Actions</div><div class="content"><ul class="keyword-actions-links"><li><a class="search-in-pubmed-link dropdown-block-link" href="/?term=%22Anticoagulants%22%5Bnm%5D&sort=date&sort_order=desc" data-href="/?term=%22Anticoagulants%22%5Bnm%5D&sort=date&sort_order=desc" ref="linksrc=search_in_pubmed_keyword_link&keyword="Anticoagulants"[nm]" data-ga-category="search" data-ga-action="substance" data-ga-label="Anticoagulants"> Search in PubMed </a></li><li><a class="search-in-mesh-link dropdown-block-link" ref="linksrc=search_in_mesh_link" href="https://www.ncbi.nlm.nih.gov/mesh?term=%22Anticoagulants%22" data-ga-category="search_mesh" data-ga-action="substance_link" data-ga-label="Anticoagulants"> Search in MeSH </a></li><li><a class="add-to-search-link dropdown-block-link" ref="linksrc=add_to_search_link" role="button" data-search-term=""Anticoagulants"[nm]" data-ga-category="search" data-ga-action="add_to_search" data-ga-label=""Anticoagulants"[nm]" href="#"> Add to Search </a></li></ul></div></div></div></li><li><div class="keyword-actions dropdown-block"><button class="keyword-actions-trigger trigger keyword-link" aria-label="Toggle dropdown menu for keyword Biomarkers" tabindex="0" aria-controls="keyword-actions-substances-1" aria-expanded="false" data-pinger-ignore> Biomarkers </button><div id="keyword-actions-substances-1" class="keyword-actions-dropdown dropdown dropdown-container" hidden aria-label="Dropdown menu for keyword Biomarkers"><div class="title">Actions</div><div class="content"><ul class="keyword-actions-links"><li><a class="search-in-pubmed-link dropdown-block-link" href="/?term=%22Biomarkers%22%5Bnm%5D&sort=date&sort_order=desc" data-href="/?term=%22Biomarkers%22%5Bnm%5D&sort=date&sort_order=desc" ref="linksrc=search_in_pubmed_keyword_link&keyword="Biomarkers"[nm]" data-ga-category="search" data-ga-action="substance" data-ga-label="Biomarkers"> Search in PubMed </a></li><li><a class="search-in-mesh-link dropdown-block-link" ref="linksrc=search_in_mesh_link" href="https://www.ncbi.nlm.nih.gov/mesh?term=%22Biomarkers%22" data-ga-category="search_mesh" data-ga-action="substance_link" data-ga-label="Biomarkers"> Search in MeSH </a></li><li><a class="add-to-search-link dropdown-block-link" ref="linksrc=add_to_search_link" role="button" data-search-term=""Biomarkers"[nm]" data-ga-category="search" data-ga-action="add_to_search" data-ga-label=""Biomarkers"[nm]" href="#"> Add to Search 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