LONDON — Gaunt and frail, his organs succumbing to the cruelly destructive power of radioactive poisoning, Alexander Litvinenko lay in a London hospital bed in November 2006 and identified the man he held responsible for his impending demise: Vladimir Putin.

Nearly a decade later, an inquiry by a British judge concluded Thursday the ex-KGB operative was probably right. For the first time, the Russian president was officially implicated in a murder that seemed plucked from a Cold War spy novel, played out in the bar of a posh hotel in 21st century London.

An outspoken critic of the Kremlin who had defected, the victim joined the payroll of British intelligence and accused Putin of vices ranging from corruption to pedophilia. The accused killers, Andrei Lugovoi and Dimitry Kovtun, were assassins who, the report found, were almost certainly acting on orders from the Russian spy service and left a trail of radioactive evidence across London. The weapons of choice: a tea cup and one massive dose of polonium.

The conclusions instantly set off a furious diplomatic row, with Britain summoning the Russian ambassador. Prime Minister David Cameron called the findings of “state-sponsored” murder in London “absolutely appalling.” A Kremlin spokesman said the report would “further poison the atmosphere.”

But Home Secretary Theresa May beat back suggestions that the British government go further.

Litvinenko’s widow, Marina Litvinenko, called yesterday for Britain to expel Russian intelligence officials and enact new sanctions.

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British officials reiterated requests for Russia to extradite the two accused killers.