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.

中文翻譯：

伊利諾伊州爆發(fā)的大麻素相關(guān)性凝血病暴發(fā)

背景

在2018年3月和2018年4月，伊利諾伊州有150多名患有凝血病和出血性疾病的醫(yī)院就診。地區(qū)醫(yī)生和公共衛(wèi)生組織確定了凝血病和合成大麻素使用之間的關(guān)聯(lián)。對(duì)患者血清樣品和藥物樣品的初步測(cè)試表明，抗凝劑溴地芬很可能會(huì)摻假。

方法

我們回顧了2018年3月28日至4月21日之間從伊利諾伊州皮奧里亞（Peoria）的圣弗朗西斯醫(yī)學(xué)中心（Saint Francis Medical Center）入院的患者的醫(yī)生報(bào)告數(shù)據(jù)，并將這些患者納入病例組，這些患者符合用于診斷合成大麻素相關(guān)性凝血病的標(biāo)準(zhǔn)。經(jīng)治療醫(yī)師酌情下令確認(rèn)性抗凝中毒專家小組下達(dá)命令。

結(jié)果

在45例住院期間，共有34例患者被確定患有合成大麻素相關(guān)性凝血病。在34例患者中的15例中進(jìn)行了確診性抗凝試驗(yàn)，在15例患者中證實(shí)了超華法林中毒。抗凝試驗(yàn)陽性的15例患者（100％）的溴地芬，5例（33％）的地芬那濃，2例（13％）的苯丁二酮和1例（7％）的華法林。呈現(xiàn)的常見癥狀包括19例（56％）的肉眼血尿和16例（47％）的腹痛。進(jìn)行計(jì)算機(jī)斷層掃描以評(píng)估12例患者的腹痛并顯示腎臟異常。在所有34例患者中口服維生素K1（植物酮），也有23例（68％）通過靜脈給藥。5例（15％）進(jìn)行了紅細(xì)胞輸注，19例（56％）進(jìn)行了新鮮冷凍血漿輸注。1名患者使用了四因子凝血酶原復(fù)合物濃縮物。一名患者死于自發(fā)性顱內(nèi)出血并發(fā)癥。

結(jié)論

我們的數(shù)據(jù)表明，合成大麻素的超華法林摻假可導(dǎo)致臨床上明顯的凝血病。在我們的系列文章中，在大多數(shù)患者表現(xiàn)出大出血的情況下，使用維生素K1替代療法可控制癥狀。具體的合成大麻素化合物尚不清楚。

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網(wǎng)址: An Outbreak of Synthetic Cannabinoid–Associated Coagulopathy in Illinois,The New England Journal of Medicine http://www.u1s5d6.cn/newsview460504.html