An Outbreak of Synthetic Cannabinoid-Associated Coagulopathy in Illinois
An Outbreak of Synthetic Cannabinoid-Associated Coagulopathy in Illinois
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DOI：
10.1056/nejmoa1807652
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发表时间：
2018-09-27
影响因子：
158.5
通讯作者：
Roberts, Jonathan C.
中科院分区：
文献类型：
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作者：
Kelkar, Amar H.;Smith, Nichole A.;Roberts, Jonathan C.
2018年3月和4月，超过150名患者因凝血功能障碍和出血素质而前往伊利诺伊州的医院。地区医生和公共卫生组织确定了凝血障碍和合成大麻素使用之间的关联。患者血清样本和药物样本的初步测试显示，brodifacoum，一种抗凝剂，是可能的adultant.METHODSWe审查了医生报告的数据，从患者入院圣弗朗西斯医疗中心在皮奥里亚，伊利诺伊州，2018年3月28日至4月21日，并包括在一个病例系列成人患者谁符合用于诊断合成大麻素相关凝血病的标准。在45次住院治疗中，共有34名患者被确定为患有合成大麻素相关凝血病。在34例患者中的15例中进行了抗凝血试验，并在15例受试患者中证实了超级华法林中毒。抗凝血试验阳性的15例患者（100%），difenacoum在5（33%），溴敌隆在2（13%），华法林在1（7%）。常见症状包括肉眼血尿19例（56%）和腹痛16例（47%）。计算机断层扫描进行评估腹痛，并发现肾脏异常的12名患者。维生素K-1（植物甲萘醌）口服给药的所有34例，也静脉注射23（68%）。红细胞输注5例（15%），新鲜冰冻血浆输注19例（56%）。1例患者使用四因子凝血酶原复合物。1例患者死于自发性颅内出血并发症。CONCLUSION我们的数据表明，合成大麻素的superwarfarin掺杂物可导致临床显著的凝血功能障碍。在我们的系列中，在大多数病例中，患者表现出出血素质，使用维生素K-1替代疗法控制了症状。具体的合成大麻素化合物是未知的。
BACKGROUNDIn 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.METHODSWe 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.RESULTSA 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 K-1 (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.CONCLUSIONSOur 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 K-1 replacement therapy. The specific synthetic cannabinoid compounds are not known.