Adherence to Long-Term Follow-Up of Patients with Life-Threatening, Inhaled Synthetic Cannabinoids-Associated Coagulopathy in Chicago
Adherence to Long-Term Follow-Up of Patients with Life-Threatening, Inhaled Synthetic Cannabinoids-Associated Coagulopathy in Chicago
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DOI：
10.1007/s00408-019-00227-2
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发表时间：
2019-06-01
期刊：
影响因子：
5
通讯作者：
Rubinstein, Israel
中科院分区：
文献类型：
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作者：
Tole, Mateo;LaBedz, Stephanie;Rubinstein, Israel
伊利诺伊州最近报告了与吸入性合成大麻素(Spice/K2)相关的危及生命的凝血障碍的大规模暴发，并伴有出血并发症。病原体是溴敌隆、苯恶草隆和溴敌隆，它们是有效的、长效的4-羟基香豆素抗凝血灭鼠剂(LAAR)，它们与获得的Spice/K2产品混合，然后由受害者吸入。我们报告了居住在芝加哥服务不足、社会经济困难的社区的3名中毒患者，他们在芝加哥两家市中心的三级护理医院成功入院并接受了治疗。患者每天出院接受长期大剂量维生素K-1(VK1)口服，免费提供。然而，2名患者在安全停止口服VK1治疗之前失去了随访。第三例患者在VK1停药后成功治疗并随访7个月。我们得出结论，长期口服VK1治疗和对急性、危及生命的Laar中毒的随访是不同的，并对医疗保健提供者提出了挑战。应该制定和实施适当的实践指南，以改善患者获得和遵守每日大剂量口服VK1治疗和后续治疗的机会。
A large-scale outbreak of life-threatening, inhaled synthetic cannabinoids (Spice/K2)-associated coagulopathy with bleeding complications was recently reported in Illinois. The causative agents were brodifacoum, difenacoum, and bromadiolone, potent, long-acting, 4-hydroxycoumarin anticoagulant rodenticides (LAAR) that were mixed with Spice/K2 products procured and then inhaled by the victims. We report on 3 poisoned patients who reside in underserved, socioeconomically disadvantaged neighborhoods of Chicago that were admitted and treated successfully at two inner-city, tertiary care hospitals in Chicago. The patients were discharged from the hospitals on daily long-term high-dose oral vitamin K-1 (VK1), provided free of charge. However, 2 patients were lost to follow-up prior to safe discontinuation of oral VK1 therapy. The third patient was treated and followed successfully for 7months when VK1 was discontinued. We conclude that prolonged oral VK1 therapy and follow-up of acute, life-threatening LAAR poisoning are variable and present challenges to healthcare providers. Appropriate practice guidelines to improve patient access and adherence to daily high-dose oral VK1 therapy and follow-up should be developed and implemented.