4887. Radiological Findings in Poisoning by Synthetic Cannabinoids Adulterated with Brodifacoum
Authors * Denotes Presenting Author
  1. Nitai Bar *; Rambam Healthcare Campus
  2. Rebeca Lopez-Alonso; Rambam Healthcare Campus
  3. Goni Merhav; Rambam Healthcare Campus
  4. Sobhi Abadi; Rambam Healthcare Campus; Technion-Israel Institute of Technology
  5. Yael Lurie; Israel Poison Information Center; Technion-Israel Institute of Technology
  6. Anat Illivitzki; Rambam Healthcare Campus
Severe coagulopathy due to consumption of synthetic cannabinoids adulterated with brodifacoum, a long-acting anticoagulant, is an emerging worldwide hazard with potential life-threatening consequences. Here, we review the spectrum of imaging findings in coagulopathy due to 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, and associations between a continuous variable and a dichotomous outcome were assessed with the Mann-Whitney U test.

We identified 48 patients (mean ± SD age 40 ± 9 y, 43 men) with 54 hospitalizations due to cannabinoid-associated coagulopathy. Symptomatic hemorrhage was documented in 50 (93%) cases at initial presentation, most of whom (78%) presented with 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, including pseudoaneurysm and retroperitoneal hemorrhage. An increased number of bleeding sites was associated with need for vasopressors (difference in bleeding sites 3.00 [95% CI 0.99 - 4.00], <em>p</em> = 0.026).

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. 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.