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Impact of marijuana on venous thromboembolic events: Cannabinoids cause clots in trauma patients

Affiliation

  • 1 From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
  • PMID: 32209959
  • DOI: 10.1097/TA.0000000000002667

Impact of marijuana on venous thromboembolic events: Cannabinoids cause clots in trauma patients

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Authors

Affiliation

  • 1 From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
  • PMID: 32209959
  • DOI: 10.1097/TA.0000000000002667

Abstract

Background: Tetrahydrocannabinoids (THC) can modulate the coagulation cascade resulting in hypercoagulability. However, the clinical relevance of these findings has not been investigated. The aim of our study was to evaluate the impact of preinjury marijuana exposure on thromboembolic complications (TEC) in trauma patients.

Methods: We performed a 2-year (2015-2016) analysis of American College of Surgeons Trauma Quality and Improvement Program database and included all adult (≥18 year) trauma patients. Patients were stratified based on preinjury exposure to Marijuana: THC + ve and THC -ve groups. We performed propensity score matching to control for confounding variables: demographics, comorbidities, injury parameters, hospital course, and thromboprophylaxis use. Outcomes were TEC (deep venous thrombosis, pulmonary embolism, stroke, myocardial infarction) and mortality.

Results: Of 593,818 trauma patients, 678 patients were matched (THC + ve: 226 vs. THC -ve: 452). Mean age was 34 ± 15 years, Injury Severity Score was 14 (10-21). There was no difference between the two groups regarding age (p = 0.75), sex (p = 0.99), Injury Severity Score (p = 0.54), spine Abbreviated Injury Scale (AIS) (p = 0.61), head AIS (p = 0.32), extremities AIS (p = 0.38), use of unfractionated heparin (p = 0.54), use of low molecular weight heparin (p = 0.54), and hospital length of stay (p = 0.87). Overall, the rate of TEC was 4.3% and mortality was 4%. Patients in THC + ve group had higher rates of TEC compared with those in THC -ve group (3.5% vs. 1.1%, p = 0.03). The rate of deep venous thrombosis (6.6% vs. 1.8%, p = 0.02) and PE (2.2% vs. 0.2%, p = 0.04) was higher in THC + ve group. However, there was no difference regarding the rate of stroke (p = 0.24), myocardial infarction (p = 0.35) and mortality (p = 0.28).

Conclusion: THC exposure increases the risk of TEC in patients with trauma. Early identification and treatment for TEC is required to improve outcomes in this high-risk subset of trauma patients.

Level of evidence: Prognostic study, level III.

Prognostic study, level III.

[Severe pulmonary embolism in a young marijuana smoker]

Affiliation

  • PMID: 22090230

[Severe pulmonary embolism in a young marijuana smoker]

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  • Search in NLM Catalog
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Authors

Affiliation

  • PMID: 22090230

Abstract

It is a popular belief, that marijuana smoking is not harmful to health. Some publications, however, suggest its possible association with mental, respiratory and cardiovascular complications, but not with venous thromboembolism. The authors describe a case of severe pulmonary embolism in a mildly obese, 22 year-old marijuana and tobacco smoker. After thrombolysis, rapid haemodynamic improvement was observed, contrary to slow regression of concomitant deep vein thrombosis during anticoagulation with warfarin. Toxycologic assessment of urine cannabinols was positive for two months. In trombophilia screening only moderate hyperhomocysteinaemia (not related to MTHFR C667T polymorphism) was found.

It is a popular belief, that marijuana smoking is not harmful to health. Some publications, however, suggest its possible association with mental, respiratory and cardiovascular complications, but not with venous thromboembolism. The authors describe a case of severe pulmonary embolism in a mildly o … ]]>