Since the index patient with hypocoagulopathy associated with the use of synthetic cannabinoids was identified on March 8, 2018, in Illinois, at least 324 individuals presented to health centers with significant bleeding due to possible exposure.
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A state-by-state breakdown of severe bleeding events (hypocoagulopathy) associated with synthetic cannabinoid use is as follows:
- Illinois (164 cases)
- Wisconsin (86 cases)
- Maryland (44 cases)
- Florida (6 cases)
- Pennsylvania (6 cases)
- Missouri (5 cases)
- North Carolina (5 cases)
- Indiana (5 cases)
- Kentucky (1 case)
- Virginia (1 case)
- West Virginia (1 case)
Laboratory research has confirmed exposure to brodifacoum in at least 150 patients. There were at least 8 deaths. Vitamin K1 is still the recommended treatment.
According to the initial HAN notice published on May 25, 2018, a pair of new clinical scenarios emerged:
- After follow-up, several patients had concentrations of brodifacoum in the blood that are higher than their initial concentrations of brodifacoum.
- At least one patient had become pregnant since the beginning of oral vitamin K1 therapy. When patients have outpatient follow-up of brodifacoum in the blood greater than their initial blood concentrations of brodifacoum, it strongly suggests that the use of synthetic cannabinoids containing brodifacoum has been continued or resumed during oral therapy with vitamin K1.
The consequences of new exposure to brodifacoum are as follows:
- Risk of life-threatening hemorrhage,
- It may be necessary to increase the oral dose of vitamin K1, and
- The duration of oral vitamin K1 therapy may need to be prolonged.
CDC recommends against the use of synthetic cannabinoids. These products are always dangerous because it is impossible to know what chemicals the products contain, how much they are exposed to, and how their bodies will react to chemicals. The synthetic cannabinoid products associated with this outbreak are particularly dangerous because they contain brodifacoum, a chemical used as a poison in rats that can cause uncontrolled bleeding.
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