Coagulopathy Cases Linked to Synthetic Cannabinoids Top 200, CDC Offers Advice to Clinicians

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH

The CDC has received reports of 202 cases of coagulopathy linked to use of synthetic cannabinoids since the first case was reported in March 2018, the agency said on Friday.

Over 95 biological samples from cases have tested positive for brodifacoum, a vitamin-K antagonist anticoagulant used in rat poison. It's believed that brodifacoum was mixed with synthetic cannabinoids, the CDC says.

Most cases have occurred in Illinois, with the remaining distributed across Florida, Indiana, Kentucky, Maryland, Missouri, Pennsylvania, Virginia, and Wisconsin. There have been five deaths.

The CDC recommends that clinicians:

• Be on alert for vitamin K-dependent antagonist coagulopathy in patients with a history of synthetic cannabinoid use.

• Ask all patients about drug use. Those who may have used synthetic cannabinoids within the past 3 months should undergo INR measurement, even in the absence of symptoms. An INR >2 can help identify potential cases.

• Ask possible cases about recent blood or plasma donation, and report such donations to the state health department.