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Adherence to Long-Term Follow-Up of Patients with Life-Threatening, Inhaled Synthetic Cannabinoids-Associated Coagulopathy in Chicago

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Abstract

A large-scale outbreak of life-threatening, inhaled synthetic cannabinoids (Spice/K2)-associated coagulopathy with bleeding complications was recently reported in Illinois. The causative agents were brodifacoum, difenacoum, and bromadiolone, potent, long-acting, 4-hydroxycoumarin anticoagulant rodenticides (LAAR) that were mixed with Spice/K2 products procured and then inhaled by the victims. We report on 3 poisoned patients who reside in underserved, socioeconomically disadvantaged neighborhoods of Chicago that were admitted and treated successfully at two inner-city, tertiary care hospitals in Chicago. The patients were discharged from the hospitals on daily long-term high-dose oral vitamin K1 (VK1), provided free of charge. However, 2 patients were lost to follow-up prior to safe discontinuation of oral VK1 therapy. The third patient was treated and followed successfully for 7 months when VK1 was discontinued. We conclude that prolonged oral VK1 therapy and follow-up of acute, life-threatening LAAR poisoning are variable and present challenges to healthcare providers. Appropriate practice guidelines to improve patient access and adherence to daily high-dose oral VK1 therapy and follow-up should be developed and implemented.

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Acknowledgements

We thank the medical personnel at University of Illinois Hospital and Jesse Brown VA Medical Center, Chicago, Illinois for providing dedicated care to these patients.

Funding

Supported by NIH Grant U01 NS083457. Dr. Feinstein is supported by Merit Review and Research Career Scientist Awards from the Department of Veterans Affairs.

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Authors and Affiliations

  1. Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine (M/C 719), University of Illinois at Chicago, 840 South Wood Street, Chicago, IL, 60612, USA

    Mateo Tole, Stephanie LaBedz & Israel Rubinstein

  2. Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, 60612, USA

    Douglas L. Feinstein

  3. Medical Service, Jesse Brown VA Medical Center, Chicago, IL, 60612, USA

    Mateo Tole, Stephanie LaBedz & Israel Rubinstein

  4. Research and Development Service, Jesse Brown VA Medical Center, Chicago, IL, 60612, USA

    Douglas L. Feinstein & Israel Rubinstein

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  1. Mateo Tole
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  2. Stephanie LaBedz
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  3. Douglas L. Feinstein
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  4. Israel Rubinstein
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Correspondence to Israel Rubinstein.

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Conflict of interest

Drs. Rubinstein and Feinstein are co-founders of EnSol Therapeutics, LLC.

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This article does not contain any studies with human participants performed by any of the authors.

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Tole, M., LaBedz, S., Feinstein, D.L. et al. Adherence to Long-Term Follow-Up of Patients with Life-Threatening, Inhaled Synthetic Cannabinoids-Associated Coagulopathy in Chicago. Lung 197, 349–352 (2019). https://doi.org/10.1007/s00408-019-00227-2

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  • DOI: https://doi.org/10.1007/s00408-019-00227-2

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