TY  - JOUR
PY  - 2023//
TI  - An outbreak of severe coagulopathy in northern Israel among users of illicit synthetic cannabinoids adulterated with brodifacoum
JO  - Clinical toxicology (Philadelphia, Pa.)
A1  - Lurie, Yael
A1  - Nadir, Yona
A1  - Hoffman, Ron
A1  - Miller, Asaf
A1  - Efrati, Edna
A1  - Ring, Gil
A1  - Sonenfeld, Dana
A1  - Bar, Nitai
A1  - Zaidani, Hisam
A1  - Strizevsky, Alexander
A1  - Asali, Mahdi
A1  - Lavon, Ophir
A1  - Kurnik, Daniel
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - INTRODUCTION: Adulteration of illicit drugs is a well-known phenomenon that may expose consumers to unexpected adverse effects. We report a large outbreak of severe coagulopathy in northern Israel during nine months in 2021-2022 among users of synthetic cannabinoids adulterated with a long-acting anticoagulant, brodifacoum. <br><br>METHODS: We performed a retrospective cohort study based on data extracted from the Israeli National Poison Information Center database and from electronic medical patient records at three participating hospitals. Confiscated drug samples and blood samples obtained at admission in a subgroup of patients were tested for the presence of long-acting anticoagulants. <br><br>RESULTS: We identified 98 patients affected by the outbreak. All patients had a prolonged international normalized ratio on admission, and in 69%, the blood was non-coagulating. For patients treated in the three participating centers (n = 72), the presenting complaint was overt bleeding in 79% of patients, most commonly in the urinary (53%) and gastrointestinal tracts (50%). The most severe complications were intracranial bleeding (4%), hemothorax (3%), pericardial bleeding (1%), and four patients died. Brodifacoum was detected in all available blood samples (median concentration 207 µg/L, interquartile range 112-349 μg/L, range 45-1,118 µg/L), and the drug samples contained both brodifacoum and the synthetic cannabinoid ADB-BUTINACA. All patients were treated with high-dose phytomenadione (vitamin K(1)) and additionally by packed red blood cell transfusions, fresh frozen plasma, and/or 4-factor prothrombin complex concentrate when indicated. The most frequent phytomenadione (vitamin K(1)) dose regimen was initially 20 mg intravenously every eight hours, and at discharge, 20 mg orally three times daily. <br><br>CONCLUSIONS: Outbreaks of severe coagulopathies in users of synthetic cannabinoids adulterated with a long-acting anticoagulant continue to erupt in different regions of the world. Rapid recognition of an outbreak requires a high index of suspicion when confronting young, otherwise healthy subjects with otherwise unexplained severe coagulopathy.<p />  <p>Language: en</p>
LA  - en
SN  - 1556-3650
UR  - http://dx.doi.org/10.1080/15563650.2023.2215402
ID  - ref1
ER  -