SHM Converge Scientific Abstract ePoster Gallery-When Sugar and Spice Are Not So Nice

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This case describes a previously healthy 32-year-old woman who developed severe, recurrent coagulopathy after using synthetic cannabinoids contaminated with brodifacoum, a long-acting vitamin K antagonist (“superwarfarin”). She initially presented with abdominal pain, hematuria, easy bruising, gingival bleeding, and hemorrhagic skin lesions. Labs showed a markedly elevated INR of 8.5 and prolonged PT/PTT, with low clotting factors II, VII, IX, and X that corrected on mixing study, supporting factor deficiency rather than an inhibitor. CT imaging revealed a hemorrhagic ovarian cyst. Brodifacoum poisoning was confirmed by a high blood level.<br /><br />She was treated with high-dose vitamin K, but she left against medical advice and took only low-dose over-the-counter vitamin K. Over the next eight weeks, she had multiple readmissions for recurrent bleeding and coagulopathy, including mucosal bleeding, leg pain and swelling from a popliteal hematoma, and later oropharyngeal swelling with bloody sputum. Each time, her INR improved in the hospital but worsened after discharge, suggesting inadequate adherence to the prolonged treatment required.<br /><br />The discussion emphasizes that brodifacoum has a much longer duration of action than warfarin and can require months of vitamin K therapy to prevent relapse. The case also highlights major barriers to care, including medication cost and possible lack of understanding of the illness. This patient was the first known case in a Tampa outbreak in November 2021, part of a larger public health event linked to contaminated synthetic cannabinoids.<br /><br />Overall, the report underscores the need to recognize brodifacoum toxicity, anticipate recurrent bleeding, and ensure sustained access to high-dose vitamin K and close follow-up.

Asset Subtitle

Ashley M. Perry

Meta Tag

Author List Ashley M. Perry

Category Clinical Vignettes

Concept Brodifacoum Toxicity

Concept Vitamin K Therapy

Concept Coagulopathy

Concept International Normalized Ratio

Concept Physical Therapy

Distinguished Finalist

Presenter Organization University of South Florida

Presenting Author Ashley M. Perry

Track Adult

Keywords

brodifacoum poisoning

synthetic cannabinoids

superwarfarin

coagulopathy

vitamin K antagonist

elevated INR

recurrent bleeding

hemorrhagic ovarian cyst

vitamin K therapy

contaminated drugs

Brodifacoum Toxicity

Vitamin K Therapy

Coagulopathy

International Normalized Ratio

Physical Therapy