An outbreak of severe coagulopathy from synthetic cannabinoids tainted with Long-Acting anticoagulant rodenticides
An outbreak of severe coagulopathy from synthetic cannabinoids tainted with Long-Acting anticoagulant rodenticides
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DOI：
10.1080/15563650.2019.1690149
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发表时间：
2019-12-03
影响因子：
3.3
通讯作者：
Aks, Steven E.
中科院分区：
文献类型：
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作者：
Devgun, Jason M.;Rasin, Arkady;Aks, Steven E.
目的：描述一个大型区域毒物中心管理与合成大麻素（SC）使用相关的长效抗凝血灭鼠剂（LAAR）中毒爆发的经验。方法：这是对2018年3月10日至8月1日期间向伊利诺伊州毒物中心报告的暴露的回顾性审查。所有编码为接触Delta 9-四氢大麻酚同系物的病例均已确定。包括疑似SC使用、LAAR检测阳性和凝血病（出血体征或症状或国际标准化比值[INR] > 2）的患者。如果进行了确证性LAAR检测且结果为阴性，则将患者从该分析中排除。在未进行LAAR检测的情况下，纳入疑似SC使用、INR >2且无凝血病替代解释的患者。疑似SC使用定义为治疗团队成员怀疑或患者报告的使用。报告了受此次疫情影响的患者的体征和症状、实验室检查结果、管理、医疗保健利用、结局和处置。结果：178例符合纳入标准。大多数患者为男性（73%）和年轻至中年（中位年龄32岁，IQR 25-40）。大多数人在皮奥里亚（35%）和库克（31%）县的医院就诊。中位住院时间为3天（IQR 2-4）。88%的患者INR >10。18例患者进行了定性抗凝试验，均为大隆阳性。其他确定的LAAR包括敌鼠灵（10/18）和溴敌隆（1/18）。63%的患者有背部、腰部或腹部疼痛; 70%的患者出现血尿。106例病例接受IV维生素K-1;未报告不良反应或过敏样反应。41例（22%）患者离开AMA。38例患者（21%）在研究期间再次住院。离开AMA的患者再次住院的可能性是其他处置患者的1.6倍。颅内出血占总病例的3%，5例死亡中有4例。结论：我们描述了一个多LAAR污染SC的爆发。患者出现不同部位出血，通常需要血液制品、因子替代品和高剂量维生素K-1来稳定病情。
Objective: To describe a large regional poison center's experience managing an outbreak of long-acting anticoagulant rodenticide (LAAR) poisoning associated with synthetic cannabinoid (SC) use. Methods: This is a retrospective review of exposures reported to the Illinois Poison Center between March 10 and August 1, 2018. All cases coded as exposure to Delta 9-tetrahydrocannabinol homologs were identified. Patients with suspected SC use, positive LAAR testing, and coagulopathy (signs or symptoms of bleeding or international normalized ratio [INR] > 2) were included. If confirmatory LAAR testing was performed and resulted as negative, the patient was excluded from this analysis. In the absence of LAAR testing, patients with suspected SC use, an INR >2, and no alternative explanation of coagulopathy were included. Suspected SC use was defined as use suspected by a member of the treating team or reported by the patient. Presenting signs and symptoms, laboratory findings, management, healthcare utilization, outcomes, and disposition of patients affected by this outbreak were reported. Results: One hundred seventy-eight cases met inclusion criteria. Most patients were male (73%) and young to middle-aged (median age 32, IQR 25-40). Most presented to hospitals in Peoria (35%) and Cook (31%) counties. Median hospitalization was three days (IQR 2-4). Eighty-eight percent of patients presented with an INR >10. Eighteen cases had qualitative anticoagulant testing, all of which were positive for brodifacoum. Other identified LAARs included difenacoum (10/18) and bromadiolone (1/18). Sixty-three percent of patients had back, flank or abdominal pain; 70% of patients presented with hematuria. One hundred six cases received IV vitamin K-1; no adverse or anaphylactoid reactions were reported. Forty-one (22%) patients left AMA. Thirty-eight patients (21%) were re-hospitalized during the study period. Patients leaving AMA were 1.6 times more likely to be re-hospitalized than patients with other dispositions. Intracranial hemorrhage, present in 3% of total cases, was present in 4 of 5 fatalities. Conclusions: We describe an outbreak of multiple LAARs contaminating SCs. Patients presented with bleeding from varied sites, often required blood products, factor replacement, and high dose vitamin K-1 for stabilization.