Coagulopathy After Synthetic Cannabinoid Use: A Case Report
Authors: Arkady Rasin, Jason M. Devgun, Daniel G. Nosal, Timothy J. Meehan, Richard B. van Breemen, Trevonne M. Thompson
Journal: Annals of Internal Medicine (2019)

Letters15 October 2019Coagulopathy After Synthetic Cannabinoid Use: A Case ReportArkady Rasin, MD, Jason M. Devgun, MD, Daniel G. Nosal, BS, Timothy J. Meehan, MD, Richard B. van Breemen, PhD, and Trevonne M. Thompson, MDArkady Rasin, MDToxikon Consortium, Chicago, Illinois (A.R., J.M.D.), Jason M. Devgun, MDToxikon Consortium, Chicago, Illinois (A.R., J.M.D.), Daniel G. Nosal, BSLinus Pauling Institute, Oregon State University, Corvallis, Oregon (D.G.N., R.B.V.), Timothy J. Meehan, MDToxikon Consortium and UI Health, Chicago, Illinois (T.J.M., T.M.T.), Richard B. van Breemen, PhDLinus Pauling Institute, Oregon State University, Corvallis, Oregon (D.G.N., R.B.V.), and Trevonne M. Thompson, MDToxikon Consortium and UI Health, Chicago, Illinois (T.J.M., T.M.T.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0321 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: In March 2018, an outbreak of coagulopathy occurred in Illinois after people smoked a synthetic cannabinoid that was believed to be contaminated with a vitamin K antagonist rodenticide (1, 2). These agents act like warfarin by inhibiting synthesis of vitamin K–dependent coagulation factors. However, second-generation vitamin K antagonist rodenticides, sometimes called superwarfarins, are far more potent and longer acting—up to a few months—than warfarin. Previous reports from this outbreak identified the vitamin K antagonist rodenticides brodifacoum, difenacoum, and bromadiolone in patient serum samples, and law enforcement had identified brodifacoum in drug samples seized during the investigation (1–3).Objective: To ...References1. North American Congress of Clinical Toxicology (NACCT) abstracts 2018. Clin Toxicol (Phila). 2018;56:912-1092. [PMID: 30238815] doi:10.1080/15563650.2018.1506610 CrossrefMedlineGoogle Scholar2. Moritz E, Austin C, Wahl M, et al. Notes from the field: outbreak of severe illness linked to the vitamin K antagonist brodifacoum and use of synthetic cannabinoids - Illinois, March-April 2018. MMWR Morb Mortal Wkly Rep. 2018;67:607-8. [PMID: 29851941] doi:10.15585/mmwr.mm6721a4 CrossrefMedlineGoogle Scholar3. Kelkar AH, Smith NA, Martial A, et al. An outbreak of synthetic cannabinoid-associated coagulopathy in Illinois. N Engl J Med. 2018;379:1216-23. [PMID: 30280655] doi:10.1056/NEJMoa1807652 CrossrefMedlineGoogle Scholar4. Hauck ZZ, Feinstein DL, van Breemen RB. LC-MS-MS analysis of brodifacoum isomers in rat tissue. J Anal Toxicol. 2016;40:304-9. [PMID: 26912564] doi:10.1093/jat/bkw008 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Toxikon Consortium, Chicago, Illinois (A.R., J.M.D.)Linus Pauling Institute, Oregon State University, Corvallis, Oregon (D.G.N., R.B.V.)Toxikon Consortium and UI Health, Chicago, Illinois (T.J.M., T.M.T.)Acknowledgment: The authors acknowledge the contributions of Renee Petzel Gimbar, PharmD, who was integral in the clinical management of this patient.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0321.This article was published at Annals.org on 27 August 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byGeneral management of the patient with novel psychoactive substance toxicityChiral liquid chromatography-tandem mass spectrometry analysis of superwarfarin rodenticide stereoisomers – Bromadiolone, difenacoum and brodifacoum – In human plasmaUnmet clinical laboratory need in patients hospitalized for acute poisoning from long-acting anticoagulant rodenticidesAssessment of synthetic cannabinoid FUB‐AMB and its ester hydrolysis metabolite in human liver microsomes and human blood samples using UHPLC–MS/MSAn outbreak of severe coagulopathy from synthetic cannabinoids tainted with Long-Acting anticoagulant rodenticidesPhytomenadione/plasma 15 October 2019Volume 171, Issue 8Page: 595-596KeywordsBlood plasmaCannabinoidsCoagulopathyDrugsHemoglobinHemorrhageHospital medicineInternational normalized ratioOutpatientsVitamin K ePublished: 27 August 2019 Issue Published: 15 October 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...