Brodifacoum contamination of synthetic cannabinoid causing unexplained coagulopathy in multiple trauma: A case report
An 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 dem...
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Elsevier
2024-06-01
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| Series: | Trauma Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S235264402400030X |
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| author | Anthony V. Thomas Mackenzie L. Johnson Anna M. Tincher Saniya Zackariya Hassaan A. Khan Uzma Rizvi Scott G. Thomas Timothy W. Noveroske Daniel H. Fulkerson Ernest E. Moore Mark M. Walsh |
| author_facet | Anthony V. Thomas Mackenzie L. Johnson Anna M. Tincher Saniya Zackariya Hassaan A. Khan Uzma Rizvi Scott G. Thomas Timothy W. Noveroske Daniel H. Fulkerson Ernest E. Moore Mark M. Walsh |
| author_sort | Anthony V. Thomas |
| collection | DOAJ |
| description | An 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. |
| format | Article |
| id | doaj-art-4ae2db7d4d80491f9d250036306375f0 |
| institution | Kabale University |
| issn | 2352-6440 |
| language | English |
| publishDate | 2024-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Trauma Case Reports |
| spelling | doaj-art-4ae2db7d4d80491f9d250036306375f02025-08-20T03:47:09ZengElsevierTrauma Case Reports2352-64402024-06-015110100710.1016/j.tcr.2024.101007Brodifacoum contamination of synthetic cannabinoid causing unexplained coagulopathy in multiple trauma: A case reportAnthony V. Thomas0Mackenzie L. Johnson1Anna M. Tincher2Saniya Zackariya3Hassaan A. Khan4Uzma Rizvi5Scott G. Thomas6Timothy W. Noveroske7Daniel H. Fulkerson8Ernest E. Moore9Mark M. Walsh10Indiana University School of Medicine, Indianapolis, IN, USAIndiana University School of Medicine, Indianapolis, IN, USAIndiana University School of Medicine, Indianapolis, IN, USADepartments of Emergency and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, USADepartments of Emergency and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, USADepartment of Mortality/Quality & Safety Data Review, Beacon Health System, South Bend, IN, USABeacon Medical Group Trauma & Surgical Research Services, South Bend, IN, USADepartment of Surgery, Saint Joseph Regional Medical Center, Mishawaka, IN, USADepartment of Neurosurgery, Beacon Medial Group, South Bend, IN, USADepartment of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, USAIndiana University School of Medicine, Indianapolis, IN, USA; Departments of Emergency and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, USA; Corresponding author at: Saint Joseph Regional Medical Center, 5215 Holy Cross Parkway, Mishawaka 46545, IN, USA.An 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.http://www.sciencedirect.com/science/article/pii/S235264402400030XSynthetic cannabinoidsBrodifacoumMultiple traumaTraffic accidentsCoagulopathyThromboelastography |
| spellingShingle | Anthony V. Thomas Mackenzie L. Johnson Anna M. Tincher Saniya Zackariya Hassaan A. Khan Uzma Rizvi Scott G. Thomas Timothy W. Noveroske Daniel H. Fulkerson Ernest E. Moore Mark M. Walsh Brodifacoum contamination of synthetic cannabinoid causing unexplained coagulopathy in multiple trauma: A case report Trauma Case Reports Synthetic cannabinoids Brodifacoum Multiple trauma Traffic accidents Coagulopathy Thromboelastography |
| title | Brodifacoum contamination of synthetic cannabinoid causing unexplained coagulopathy in multiple trauma: A case report |
| title_full | Brodifacoum contamination of synthetic cannabinoid causing unexplained coagulopathy in multiple trauma: A case report |
| title_fullStr | Brodifacoum contamination of synthetic cannabinoid causing unexplained coagulopathy in multiple trauma: A case report |
| title_full_unstemmed | Brodifacoum contamination of synthetic cannabinoid causing unexplained coagulopathy in multiple trauma: A case report |
| title_short | Brodifacoum contamination of synthetic cannabinoid causing unexplained coagulopathy in multiple trauma: A case report |
| title_sort | brodifacoum contamination of synthetic cannabinoid causing unexplained coagulopathy in multiple trauma a case report |
| topic | Synthetic cannabinoids Brodifacoum Multiple trauma Traffic accidents Coagulopathy Thromboelastography |
| url | http://www.sciencedirect.com/science/article/pii/S235264402400030X |
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