دورية أكاديمية
Radiological findings in poisoning by synthetic cannabinoids adulterated with brodifacoum.
العنوان: | Radiological findings in poisoning by synthetic cannabinoids adulterated with brodifacoum. |
---|---|
المؤلفون: | Bar N; Department of Radiology, Rambam Health Care Campus, Haifa, Israel. yourfriendnitai@gmail.com., Lopez-Alonso R; Department of Radiology, Rambam Health Care Campus, Haifa, Israel., Merhav G; Department of Radiology, Rambam Health Care Campus, Haifa, Israel., Naaman E; Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel., Leiderman M; Department of Radiology, Rambam Health Care Campus, Haifa, Israel., Ilivitzki A; Department of Radiology, Rambam Health Care Campus, Haifa, Israel.; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel., Lurie Y; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.; Israel Poison Information Center, Rambam Health Care Campus, Haifa, Israel.; Section of Clinical Pharmacology and Toxicology, Rambam Health Care Campus, Haifa, Israel., Kurnik D; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.; Section of Clinical Pharmacology and Toxicology, Rambam Health Care Campus, Haifa, Israel., Abadi S; Department of Radiology, Rambam Health Care Campus, Haifa, Israel.; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. |
المصدر: | European radiology [Eur Radiol] 2024 Jul; Vol. 34 (7), pp. 4540-4549. Date of Electronic Publication: 2023 Dec 21. |
نوع المنشور: | Journal Article |
اللغة: | English |
بيانات الدورية: | Publisher: Springer International Country of Publication: Germany NLM ID: 9114774 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1084 (Electronic) Linking ISSN: 09387994 NLM ISO Abbreviation: Eur Radiol Subsets: MEDLINE |
أسماء مطبوعة: | Original Publication: Berlin : Springer International, c1991- |
مواضيع طبية MeSH: | Cannabinoids*/poisoning , 4-Hydroxycoumarins*/poisoning, Humans ; Male ; Adult ; Female ; Retrospective Studies ; Israel/epidemiology ; Middle Aged ; Tomography, X-Ray Computed ; Drug Contamination ; Anticoagulants/poisoning ; Blood Coagulation Disorders/chemically induced |
مستخلص: | Objectives: Severe coagulopathy due to consumption of synthetic cannabinoids adulterated with brodifacoum, a long-acting anticoagulant, is an emerging worldwide hazard. Here, we review the spectrum of imaging findings in adulterated cannabinoid poisoning. Materials and Methods: In this retrospective study, we used the Israeli Poison Information Center database to identify patients with cannabinoid-associated coagulopathy who presented to the Rambam Health Care Campus, where most patients were treated during an outbreak in northern Israel between September 2021 and June 2022. All relevant imaging studies for these patients were reviewed. We estimated the sensitivity of findings for cannabinoid-associated coagulopathy. Associations between a continuous variable and a dichotomous outcome were assessed with the Mann-Whitney U test. Results: We identified 48 patients (mean age 40 years ± 9 [SD], 43 males) with 54 hospitalizations due to cannabinoid-associated coagulopathy. Symptomatic hemorrhage was documented in 50 (93%) cases at presentation, most of whom (78%) had hemorrhage from multiple systems. The most common bleeding site was the genitourinary collecting system, with a characteristic sign of suburothelial bleeding in 16/18 of performed abdominal CTs (sensitivity 89% [CI 65-99%] for cannabinoid-associated coagulopathy). Intramural bowel hematomas were noted in 70% (7/10) of CTs of patients with gastrointestinal bleeding. Incidental bleeding sites were identified on imaging in 24% of patients. An increased number of bleeding sites was associated with need for vasopressors (difference in bleeding sites 3.00 [95% CI 0.99-4.00], p = 0.026). Conclusion: CT plays a key role in the diagnosis and work-up of adulterated cannabinoid-associated coagulopathy. Characteristic signs include suburothelial hemorrhage and intramural bowel hematomas. Clinical Relevance Statement: Recognition of radiological signs of adulterated synthetic cannabinoid-associated coagulopathy is critical for optimizing outbreak control on the public health level and ensuring timely treatment on the individual patient level. Key Points: • Severe coagulopathy due to consumption of synthetic cannabinoids adulterated with brodifacoum, a long-acting anticoagulant, is an emerging worldwide threat. • Characteristic imaging signs include suburothelial bleeding, intramural bowel hematomas, and rare incidental bleeding sites. • Imaging has a pivotal role in optimizing outbreak control and ensuring timely and appropriate treatment. (© 2023. The Author(s), under exclusive licence to European Society of Radiology.) |
التعليقات: | Comment in: Eur Radiol. 2024 Jul;34(7):4538-4539. doi: 10.1007/s00330-023-10532-3. (PMID: 38133676) |
References: | Alves VL, Gonçalves JL, Aguiar J et al (2020) The synthetic cannabinoids phenomenon: from structure to toxicological properties. A review. Crit Rev Toxicol 50:359–382. https://doi.org/10.1080/10408444.2020.1762539. (PMID: 10.1080/10408444.2020.176253932530350) Berkovitz R, Arieli M, Marom E (2011) Synthetic cannabinoids–the new “legal high” drugs. Harefuah 150(884–7):937. (PMID: 22352277) Kelkar AH, Smith NA, Martial A et al (2018) An Outbreak of Synthetic Cannabinoid-Associated Coagulopathy in Illinois. N Engl J Med 379:1216–1223. https://doi.org/10.1056/NEJMoa1807652. (PMID: 10.1056/NEJMoa180765230280655) Arepally GM, Ortel TL (2019) Bad weed: synthetic cannabinoid–associated coagulopathy. Blood 133:902–905. https://doi.org/10.1182/blood-2018-11-876839. (PMID: 10.1182/blood-2018-11-87683930655273) Lurie Y, Nadir Y, Hoffman R et al (2023) An outbreak of severe coagulopathy in northern Israel among users of illicit synthetic cannabinoids adulterated with brodifacoum. Clin Toxicol 61:429–435. https://doi.org/10.1080/15563650.2023.2215402. (PMID: 10.1080/15563650.2023.2215402) Feinstein DL, Hafner J, van Breemen R, Rubinstein I (2022) Inhaled synthetic cannabinoids laced with long-acting anticoagulant rodenticides: a clear and present worldwide danger. Toxicol Commun 6:28–29. https://doi.org/10.1080/24734306.2022.2025690. (PMID: 10.1080/24734306.2022.2025690354498259017862) Wells ML, Hansel SL, Bruining DH et al (2018) CT for Evaluation of Acute Gastrointestinal Bleeding. Radiographics 38:1089–1107. https://doi.org/10.1148/rg.2018170138. (PMID: 10.1148/rg.201817013829883267) Sugi MD, Menias CO, Lubner MG et al (2018) CT Findings of Acute Small-Bowel Entities. Radiographics 38:1352–1369. https://doi.org/10.1148/rg.2018170148. (PMID: 10.1148/rg.201817014830207931) Lefebvre S, Fourel I, Queffélec S et al (2017) Poisoning by Anticoagulant Rodenticides in humans and animals: causes and consequences. In: Poisoning - from specific toxic agents to novel rapid and simplified techniques for analysis. InTech Open, London, UK. https://doi.org/10.5772/intechopen.69955. Feinstein DL, Nosal DG, Ramanathan S et al (2020) Effects of vitamin K1 treatment on plasma concentrations of long-acting anticoagulant rodenticide enantiomers following inhalation of contaminated synthetic cannabinoids. Clin Toxicol 58:716–724. https://doi.org/10.1080/15563650.2019.1687903. (PMID: 10.1080/15563650.2019.1687903) Chong Y-K, Mai TW-L (2019) Superwarfarin (Long-Acting Anti-coagulant Rodenticides) Poisoning: from Pathophysiology to Laboratory-Guided Clinical Management. Clin Biochem Rev 40:175–185. https://doi.org/10.33176/AACB-19-00029. (PMID: 10.33176/AACB-19-00029318577396892705) Vinogradova Y, Coupland C, Hill T, Hippisley-Cox J (2018) Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting: cohort study in primary care. BMJ k2505. https://doi.org/10.1136/bmj.k2505. Piran S, Schulman S (2019) Treatment of bleeding complications in patients on anticoagulant therapy. Blood 133:425–435. https://doi.org/10.1182/blood-2018-06-820746. (PMID: 10.1182/blood-2018-06-82074630559261) Chen YA, Kirpalani A, Colak E (2013) A Case of Anticoagulation-related Suburothelial Hemorrhage. Urology 81:e42–e43. https://doi.org/10.1016/j.urology.2012.10.007. (PMID: 10.1016/j.urology.2012.10.00723622772) Gayer G, Desser TS, Hertz M et al (2011) Spontaneous Suburothelial Hemorrhage in Coagulopathic Patients: CT Diagnosis. AJR Am J Roentgenol 197:W887–W890. https://doi.org/10.2214/AJR.11.6474. (PMID: 10.2214/AJR.11.647422021537) Panigrahi B, Jones BC, Rowe SP (2018) Brodifacoum-contaminated synthetic marijuana: clinical and radiologic manifestations of a public health outbreak causing life-threatening coagulopathy. Emerg Radiol 25:715–718. https://doi.org/10.1007/s10140-018-1628-5. (PMID: 10.1007/s10140-018-1628-530022308) Abdel Samie A, Theilmann L (2012) Detection and management of spontaneous intramural small bowel hematoma secondary to anticoagulant therapy. Expert Rev Gastroenterol Hepatol 6:553–559. https://doi.org/10.1586/egh.12.33. (PMID: 10.1586/egh.12.3323061706) Abbas MA, Collins JM, Olden KW (2002) Spontaneous Intramural Small-Bowel Hematoma: Imaging Findings and Outcome. AJR Am J Roentgenol 179:1389–1394. https://doi.org/10.2214/ajr.179.6.1791389. (PMID: 10.2214/ajr.179.6.179138912438021) |
فهرسة مساهمة: | Keywords: Anticoagulants; Cannabinoids; Hemorrhage; Poisoning |
المشرفين على المادة: | 0 (Cannabinoids) A25P3CP5S7 (bromfenacoum) 0 (4-Hydroxycoumarins) 0 (Anticoagulants) |
تواريخ الأحداث: | Date Created: 20231221 Date Completed: 20240628 Latest Revision: 20240712 |
رمز التحديث: | 20240712 |
DOI: | 10.1007/s00330-023-10496-4 |
PMID: | 38127072 |
قاعدة البيانات: | MEDLINE |
تدمد: | 1432-1084 |
---|---|
DOI: | 10.1007/s00330-023-10496-4 |