Related Experiment Video
Updated: Feb 4, 2026
Tobacco Hornworm as an Insect Model System for Cannabinoid Pre-clinical Studies
Published on: December 29, 2021
An Outbreak of Synthetic Cannabinoid-Associated Coagulopathy in Illinois
Amar H Kelkar1, Nichole A Smith1, Annia Martial1
1From the Departments of Medicine (A.H.K., N.A.S., A.M., H.M., M.D.T.) and Pediatrics (M.D.T., J.C.R.), University of Illinois College of Medicine at Peoria, and the Bleeding and Clotting Disorders Institute (M.D.T., J.C.R.) - both in Peoria.
Insights
Synthetic cannabinoid use was linked to severe bleeding and coagulopathy in Illinois patients. Brodifacoum, a potent anticoagulant, was identified as the adulterant, with vitamin K1 therapy proving effective for most cases.
Area of Science:
- Toxicology
- Public Health
- Emergency Medicine
Background:
- Over 150 patients in Illinois presented with coagulopathy and bleeding in March-April 2018.
- Physicians identified a link between coagulopathy and synthetic cannabinoid use.
- Preliminary analysis indicated brodifacoum, a potent anticoagulant, as the likely adulterant.
Purpose of the Study:
- To investigate the association between synthetic cannabinoid use and coagulopathy.
- To identify the specific adulterants responsible for the observed coagulopathy.
- To describe the clinical presentation and management of affected patients.
Main Methods:
- A case series was conducted reviewing physician-reported data from 34 adult patients admitted to Saint Francis Medical Center.
- Patients met diagnostic criteria for synthetic cannabinoid-associated coagulopathy.
- Confirmatory anticoagulant poisoning panels were performed on 15 patients.
Main Results:
- Superwarfarin poisoning was confirmed in all 15 tested patients.
- Brodifacoum was identified in 100% of tested patients, with other superwarfarins also detected.
- Common symptoms included hematuria and abdominal pain; vitamin K1 therapy was administered to all patients.
Conclusions:
- Superwarfarin adulteration of synthetic cannabinoids can cause severe coagulopathy.
- Vitamin K1 replacement therapy was effective in managing bleeding diathesis in most cases.
- The specific synthetic cannabinoid compounds involved remain unknown.
Background:
In March and April 2018, more than 150 patients presented to hospitals in Illinois with coagulopathy and bleeding diathesis. Area physicians and public health organizations identified an association between coagulopathy and synthetic cannabinoid use. Preliminary tests of patient serum samples and drug samples revealed that brodifacoum, an anticoagulant, was the likely adulterant.
Methods:
We reviewed physician-reported data from patients admitted to Saint Francis Medical Center in Peoria, Illinois, between March 28 and April 21, 2018, and included in a case series adult patients who met the criteria used to diagnose synthetic cannabinoid-associated coagulopathy. A confirmatory anticoagulant poisoning panel was ordered at the discretion of the treating physician.
Results:
A total of 34 patients were identified as having synthetic cannabinoid-associated coagulopathy during 45 hospitalizations. Confirmatory anticoagulant testing was performed in 15 of the 34 patients, and superwarfarin poisoning was confirmed in the 15 patients tested. Anticoagulant tests were positive for brodifacoum in 15 patients (100%), difenacoum in 5 (33%), bromadiolone in 2 (13%), and warfarin in 1 (7%). Common symptoms at presentation included gross hematuria in 19 patients (56%) and abdominal pain in 16 (47%). Computed tomography was performed to evaluate abdominal pain and revealed renal abnormalities in 12 patients. Vitamin K1 (phytonadione) was administered orally in all 34 patients and was also administered intravenously in 23 (68%). Red-cell transfusion was performed in 5 patients (15%), and fresh-frozen plasma infusion in 19 (56%). Four-factor prothrombin complex concentrate was used in 1 patient. One patient died from complications of spontaneous intracranial hemorrhage.
Conclusions:
Our data indicate that superwarfarin adulterants of synthetic cannabinoids can lead to clinically significant coagulopathy. In our series, in most of the cases in which the patient presented with bleeding diathesis, symptoms were controlled with the use of vitamin K1 replacement therapy. The specific synthetic cannabinoid compounds are not known.
Related Concept Videos
01:18Steps in Outbreak Investigation
02:55Synthetic Biology
Golden rice
Golden rice is a genetically modified...
01:24CNS Stimulants: Cocaine, Amphetamines and Cannabinoids
01:21Chemotherapy-Induced Nausea and Vomiting: Cannabinoids
Two synthetic agonists of THC,...
01:28Synthetic Disvision of Polynomials
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids