Hematologist Tom Deloughery discusses recent cases of severe bleeding caused by use of synthetic marijuana tainted with the rodenticide brodifacoum. Brodifacoum is a vitamin K antagonist 10 times stronger than warfarin with a 20-30 day half life.
On lab testing, both INR and PTT are elevated, but fibrinogen unchanged.
Vitamin K is the antidote and requires prolonged treatment at high doses (up to 100mg per dose).
Consider giving prothrombin complex concentrate in patients with CNS or potential life threatening bleeding.
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