Kelkar AH, et al. - Researchers focused on the outbreak of synthetic cannabinoid–associated coagulopathy that occurred March-April 2018 in Illinois. During this outbreak, > 150 patients presented to hospitals with coagulopathy and bleeding diathesis. A link between coagulopathy and synthetic cannabinoid use was identified by area physicians and public health organizations. Serum samples and drug samples of patients were tested, and initial reports revealed that brodifacoum, an anticoagulant, was the likely adulterant. According to findings of this study, the occurrence of clinically significant coagulopathy could be attributed to superwarfarin adulterants of synthetic cannabinoids. Vitamin K1 replacement therapy was found to result in symptom control in most of the cases of the series in which the patient presented with bleeding diathesis. The specific synthetic cannabinoid compounds were not known.

Methods

• Investigators reviewed the physician-reported data from patients admitted to Saint Francis Medical Center in Peoria, IL, between March 28 and April 21, 2018, and analyzed the case series of adult patients who met the criteria used to diagnose synthetic cannabinoid–associated coagulopathy.
• At the discretion of the treating physician, a confirmatory anticoagulant poisoning panel was ordered.

Results

• During 45 hospitalizations, synthetic cannabinoid–associated coagulopathy was detected in a total of 34 patients.
• Of these patients, 15 underwent confirmatory anticoagulant testing, and superwarfarin poisoning was confirmed in all.
• Anticoagulant tests were positive for brodifacoum in 100% of patients, difenacoum in 33%, bromadiolone in 13%, and warfarin in 7%.
• Gross hematuria in 19 patients (56%) and abdominal pain in 16 (47%) comprised symptoms that were commonly documented at presentation.
• Abdominal pain was assessed using computed tomography and revealed renal abnormalities in 12 patients.
• Oral administration of vitamin K1 (phytonadione) in all 34 patients and its intravenous administration in 23 (68%) was reported.
• Five patients (15%) had red-cell transfusion and 19 (56%) received fresh-frozen plasma infusion.
• Use of four-factor prothrombin complex concentrate in one patient was reported.
• Complications of spontaneous intracranial hemorrhage led to death of one patient.