An Outbreak of Synthetic Cannabinoid-Associated Coagulopathy in Illinois

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.