389 Severe Vitamin K-Dependent Coagulopathy Associated With Contaminated Synthetic Cannabinoid Exposure in Illinois

Abstract

In Illinois during the spring of 2018, a large public outbreak of vitamin-K dependent coagulopathies occurred secondary to inhalation of contaminated synthetic cannabinoids. The hematologic effects were secondary to brodifacoum (a rodenticide anticoagulant) contamination of the product, and encompass the first large brodifacoum poisoning from the inhalational route. This study seeks to characterize the victims and patterns of the outbreak. A retrospective cohort trial was conducted at 2 Illinois academic urban emergency departments (annual visits >85,000 and >120,000) of patients with suspected brodifacoum related coagulopathy from contaminated synthetic cannabinoids presenting to the emergency department. Patients were identified from internal and public health registries, from patients either self-identifying as having an exposure, or identified by hospital providers as having an exposure. ED and hospital charts were abstracted using defined variables and all data was de-identified prior to analysis. Descriptive statistics were used to describe the population, define common symptomatology, and identify successful treatment regimens. 38 patients were enrolled in the study (33 and 5 per institution). Patients were mostly adult males (68.8%), white (76.3%) and regular users of synthetic cannabinoids (72.7%). Hematuria (68.6%), hematemesis (25.8%), melena/bloody stools (20%), and hemoptysis (17.4%) were the most common bleeding presentations to the ED. Most patients (75%) presented >24 hours post exposure. Few patients had additional illicit drug or antiplatelet/anticoagulant presence. Most received between 10-50 mg of vitamin K initially, and 48.5% received FFP in either the ED or during hospitalization. Most patients were hospitalized with a mean of 4.1 days (SD 3.1) with 12 patients leaving against medical advice. Patients had a mean presenting INR of 14.5 (SD 6.3) and a discharge INR of 2.5 (SD 1.3). Most patients were discharged with a vitamin K dose of 50 mg BID (range 0 - 50 mg) and a mean duration of treatment post discharge of 26.7 days. In addition, 42.4% of patients returned to the ED for further care after their initial visit (range 0 - 5 visits). The 2018 Illinois synthetic cannabinoid vitamin K-dependent coagulopathy outbreak was the largest inhalational brodifacoum associated population poisoning to date. Most patients presented with gastrointestinal and genitourinary associated bleeding and required large doses of vitamin K in an inpatient setting.