Cocaine Use is Associated with More Rapid Clot Formation and Weaker Clot Strength in Acute Stroke Patients.

Autor:	Almaghrabi TS; Department of Internal Medicine, University of Tabuk, Tabuk, Saudi Arabia., McDonald MM; Department of Neurology, University of Virginia School of Medicine, Virginia, USA., Cai C; Department of Internal Medicine, University of Texas Medical School at Houston, Texas, USA., Rahbar MH; Department of Internal Medicine, University of Texas Medical School at Houston, Texas, USA., Choi HA; Departments of Neurosurgery and Neurology, University of Texas Medical School at Houston, Texas, USA., Lee K; Department of Neurology, Robert Wood Johnson Medical School, New Jersey, USA., Naval NS; Department of Neurosurgery, Baptist Medical Center, Florida, USA., Grotta JC; Department of Neurology, Memorial Hermann Hospital, Texas, USA., Chang TR; Departments of Neurosurgery and Neurology, University of Texas Medical School at Houston, Texas, USA.
Jazyk:	angličtina
Zdroj:	International journal of cerebrovascular disease and stroke [Int J Cerebrovasc Dis Stroke] 2019; Vol. 2 (1). Date of Electronic Publication: 2019 Jan 18.
Abstrakt:	Introduction: 1.1.Cocaine use is a known risk factor for stroke and has been associated with worse outcomes. Cocaine may cause an altered coagulable state by a number of different proposed mechanisms, including platelet activation, endothelial injury, and tissue factor expression. This study analyzes the effect of cocaine use on Thrombelastography (TEG) in acute stroke patients. Patient and Methods: 1.2.Patients presenting with Acute Ischemic Stroke (AIS) and spontaneous Intracerebral Hemorrhage (ICH) to a single academic center between 2009 and 2014 were prospectively enrolled. Blood was collected for TEG analysis at the time of presentation. Patient demographics and baseline TEG values were compared between two groups: cocaine and non-cocaine users. Multivariable Quantile regression models were used to compare the median TEG components between groups after controlling for the effect of confounders. Results: 1.3.91 patients were included, 53 with AIS and 38 with ICH. 8 (8.8%) patients were positive for cocaine, 4 (50%) with AIS, and 4 (50%) with ICH. There were no significant differences in age, blood pressure, platelet count, or PT/PTT between the cocaine positive and cocaine negative group. Following multivariable analysis, and adjusting for factors known to influence TEG including stroke subtype, cocaine use was associated with shortened median R time (time to initiate clotting) of 3.8 minutes compared to 4.8 minutes in non-cocaine users (p=0.04). Delta (thrombin burst) was also earlier among cocaine users (0.4 minutes) compared with non-cocaine users (0.5 min, p=0.04). The median MA and G (measurements of final clot strength) were reduced in cocaine users (MA=62.5 mm, G=7.8 dynes/cm2) compared to non-cocaine users (MA=66.5 mm, G=10.1 dynes/cm2; p=0.047, p=0.04, respectively). Conclusion: 1.4.Cocaine users demonstrate more rapid clot formation but reduced overall clot strength based on admission TEG values. Competing Interests: Conflicts of Interest The authors declare no conflicts of interest.
Databáze:	MEDLINE
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