SHM Converge Scientific Abstract ePoster Gallery-An Unusual Case of Synthetic Cannabinoid-Associated Coagulopathy

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This case report describes a 29-year-old man who developed life-threatening bleeding after using synthetic marijuana. He presented with persistent bleeding from a fractured upper molar after a minor fall. Although his vital signs were stable, laboratory testing showed significant coagulopathy, including an elevated INR of 5.14, prolonged PT, and prolonged PTT. A mixing study suggested a factor deficiency rather than an inhibitor. He was treated with vitamin K and fresh frozen plasma, after which his coagulation values normalized and bleeding stopped. His hemoglobin dropped the next day, but he recovered and was discharged with counseling to avoid synthetic cannabinoids.<br /><br />The report highlights an emerging public health problem: synthetic marijuana products may be contaminated with long-acting anticoagulant rodenticides, especially brodifacoum, which causes severe vitamin K–dependent coagulopathy. Brodifacoum is highly lipophilic and has a very long half-life, making anticoagulation prolonged and sometimes requiring extended vitamin K therapy.<br /><br />Management depends on severity. In major bleeding, reversal may require fresh frozen plasma or prothrombin complex concentrate, along with vitamin K. Because there is no standard vitamin K dosing regimen and prolonged treatment may be needed, clinicians should involve poison control for guidance and reporting.<br /><br />The key takeaway is that healthcare providers should recognize synthetic cannabinoid–associated coagulopathy as a potentially fatal condition that can present with anything from abnormal labs to severe hemorrhage. Early identification and prompt reversal are essential.

Asset Subtitle

Keir F. MacKay

Meta Tag

Author List Keir F. MacKay, Mohammad Ishaq

Category Clinical Vignettes

Concept Synthetic Cannabinoid Use

Concept Coagulopathy

Concept Bleeding

Concept Long-Acting Anticoagulant Rodenticide

Concept Brodifacoum

Distinguished Non-Finalist

Presenter Organization Southwest Indiana Internal Medicine Residency (Indiana University)

Presenting Author Keir F. MacKay

Track Adult

Keywords

synthetic marijuana

coagulopathy

brodifacoum

vitamin K deficiency

bleeding

elevated INR

fresh frozen plasma

prothrombin complex concentrate

synthetic cannabinoids

rodenticide contamination

Synthetic Cannabinoid Use

Coagulopathy

Bleeding

Long-Acting Anticoagulant Rodenticide

Brodifacoum