Affiliation:
1. Department of Anesthesiology, Boston Medical Center, Boston, MA 02118, USA
2. Department Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clínico Universitario de Valencia, University of Valencia, 46010 Valencia, Spain
3. Department of Anesthesiology and Critical Care, Sapienza University of Rome, 00185 Rome, Italy
Abstract
Cocaine consumption has increased over the last decade. The potent sympathomimetic effects of the drug can lead to serious neurovascular complications in the form of ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). This systematic review and meta-analysis were designed to describe the clinical features and outcomes of patients suffering from IS, ICH, or SAH occurring in the context of cocaine use. The PubMed, Embase, Cochrane, and Web of Science libraries were queried in December 2022. Studies were included if they provided information regarding the epidemiology, clinical presentation, or outcomes in cocaine-associated strokes. Odds ratios (OR) were pooled using a random-effects model. A total of 36 papers were included. Strokes associated with cocaine use were more prevalent in younger populations and those of African American descent. Cocaine use increased the odds of IS, ICH, or SAH (OR = 5.05, p < 0.001). The odds of mortality (OR = 1.77, p = 0.0021), vasospasm (OR = 2.25, p = 0.0037), and seizures (OR = 1.61, p < 0.001) were also worse when strokes were associated with cocaine use. In addition to counseling patients on the benefits of drug cessation, clinicians should remain vigilant of the potential complications in patients who are hospitalized with cocaine-associated strokes.
Reference58 articles.
1. United Nations (2023, August 02). World Drug Report 2021 [Internet]. Available online: https://www.unodc.org/res/wdr2021/field/WDR21_Booklet_4.pdf.
2. Substance Abuse and Mental Health Services Administration (2023, August 02). Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health, Available online: https://www.samhsa.gov/data/sites/default/files/reports/rpt35325/NSDUHFFRPDFWHTMLFiles2020/2020NSDUHFFR1PDFW102121.pdf.
3. (2016). Meyler’s Side Effects of Drugs [Internet], Elsevier. Available online: https://linkinghub.elsevier.com/retrieve/pii/B9780444537171005369.
4. Levine, B.S., and Kerrigan, S. (2020). Principles of Forensic Toxicology [Internet], Springer International Publishing. Available online: http://link.springer.com/10.1007/978-3-030-42917-1_23.
5. Cardiovascular Effects of Cocaine;Schwartz;Circulation,2010