Author: Rachel Beham, PharmD

Educational Pearls:

• Some synthetic cannabinoids have been contaminated with Brodifacoum. Brodifacoum is a Vitamin K antagonist and can present with a severe coagulopathy.

• Brodifacoum is commonly known as "superwarfarin" and has a very long half life of 120+ days.

• Check PT/INR in patients with a bleeding diathesis in setting of synthetic cannabinoid use.

• Treatment is activated charcoal and large doses of Vitamin K (10mg Q6H for months).

References:

Lipton R.A.; Klass E.M. (1984). "Human ingestion of a 'superwarfarin' rodenticide resulting in a prolonged anticoagulant effect". JAMA. 252: 3004–3005.

La Rosa F; Clarke S; Lefkowitz J. B. (1997). "Brodifacoum intoxication with marijuana smoking". Archives of Pathology & Laboratory Medicine. 121: 67–69