Brodifacoum contamination of synthetic cannabinoid causing unexplained coagulopathy in multiple trauma: A case report

dc.contributor.authorThomas, Anthony V.
dc.contributor.authorJohnson, Mackenzie L.
dc.contributor.authorTincher, Anna M.
dc.contributor.authorZackariya, Saniya
dc.contributor.authorKhan, Hassaan
dc.contributor.authorRizvi, Uzma
dc.contributor.authorThomas, Scott G.
dc.contributor.authorNoveroske, Timothy W.
dc.contributor.authorFulkerson, Daniel H.
dc.contributor.authorMoore, Ernest E.
dc.contributor.authorWalsh, Mark M.
dc.contributor.departmentMedicine, School of Medicine
dc.date.accessioned2024-07-15T10:25:38Z
dc.date.available2024-07-15T10:25:38Z
dc.date.issued2024-04-01
dc.description.abstractAn 18-year-old female presented to the emergency department after a motor vehicle collision. Initial imaging revealed a liver laceration. Subsequent labs showed significantly elevated prothrombin time, international normalized ratio, and activated partial thromboplastin time. Thromboelastography demonstrated a flatline tracing. The patient denied use of anticoagulation but admitted to synthetic cannabinoid use. It was believed the patient had taken synthetic cannabinoid contaminated by brodifacoum. She was therefore given prothrombin complex concentrate and vitamin K with blood products. The patient underwent sequential embolization, laparotomy, thoracotomy, and repair of the vena cava with a shunt. Thirty minutes postoperatively, her coagulation tests and thromboelastography were much improved. Two and a half hours postoperatively, it was determined she had sustained non-survivable injuries. The patient experienced brain death due to prolonged hypotension as a result of hemorrhagic shock with bleeding exacerbated by brodifacoum. To our knowledge, this is the first case reported of a trauma-induced coagulopathy exacerbated by brodifacoum-contaminated synthetic cannabinoid. Her coagulopathy was clearly not due to trauma alone and contributed greatly to the difficulty in controlling hemorrhage. The synthetic cannabinoid-associated coagulopathy rendered her otherwise potentially survivable injuries fatal. Given the frequency of multiple trauma and the recent increase in the prevalence of synthetic cannabinoid, it can be expected that the incidence of trauma complicated by synthetic cannabinoid-associated coagulopathy will increase in the near future. For patients that present with prolonged prothrombin time and/or activated partial thromboplastin time, it is important to inquire about recent synthetic cannabinoid use.
dc.eprint.versionFinal published version
dc.identifier.citationThomas AV, Johnson ML, Tincher AM, et al. Brodifacoum contamination of synthetic cannabinoid causing unexplained coagulopathy in multiple trauma: A case report. Trauma Case Rep. 2024;51:101007. Published 2024 Apr 1. doi:10.1016/j.tcr.2024.101007
dc.identifier.urihttps://hdl.handle.net/1805/42191
dc.language.isoen_US
dc.publisherElsevier
dc.relation.isversionof10.1016/j.tcr.2024.101007
dc.relation.journalTrauma Case Reports
dc.rightsAttribution 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourcePMC
dc.subjectSynthetic cannabinoids
dc.subjectBrodifacoum
dc.subjectMultiple trauma
dc.subjectTraffic accidents
dc.subjectCoagulopathy
dc.subjectThromboelastography
dc.titleBrodifacoum contamination of synthetic cannabinoid causing unexplained coagulopathy in multiple trauma: A case report
dc.typeArticle
Files
Original bundle
Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
Thomas2024Brodifacoum-CCBY.pdf
Size:
746.7 KB
Format:
Adobe Portable Document Format
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
2.04 KB
Format:
Item-specific license agreed upon to submission
Description: