Tareq S Almaghrabi1, Mark M McDonald2, Chunyan Cai3, Mohammed H Rahbar3, H Alex Choi4, Kiwon Lee5, Neeraj S Naval6, James C Grotta7, Tiffany R Chang4. 1. Department of Internal Medicine, University of Tabuk, Tabuk, Saudi Arabia. 2. Department of Neurology, University of Virginia School of Medicine, Virginia, USA. 3. Department of Internal Medicine, University of Texas Medical School at Houston, Texas, USA. 4. Departments of Neurosurgery and Neurology, University of Texas Medical School at Houston, Texas, USA. 5. Department of Neurology, Robert Wood Johnson Medical School, New Jersey, USA. 6. Department of Neurosurgery, Baptist Medical Center, Florida, USA. 7. Department of Neurology, Memorial Hermann Hospital, Texas, USA.
Abstract
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.
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.
Authors: Tiffany R Chang; Robert G Kowalski; Filissa Caserta; Juan Ricardo Carhuapoma; Rafael J Tamargo; Neeraj S Naval Journal: Stroke Date: 2013-05-07 Impact factor: 7.914
Authors: Jaime Pereira; Claudia G Sáez; Julio Pallavicini; Olga Panes; Karla Pereira-Flores; Manuel J Cabreras; Teresa Massardo; Diego Mezzano Journal: Platelets Date: 2011-08-02 Impact factor: 3.862
Authors: Sheryl Martin-Schild; Karen C Albright; Hen Hallevi; Andrew D Barreto; Maria Philip; Vivek Misra; James C Grotta; Sean I Savitz Journal: Stroke Date: 2010-02-25 Impact factor: 7.914
Authors: S R Levine; J C Brust; N Futrell; K L Ho; D Blake; C H Millikan; L M Brass; P Fayad; L R Schultz; J F Selwa Journal: N Engl J Med Date: 1990-09-13 Impact factor: 91.245
Authors: William E Hobbs; Emily E Moore; Rebecca A Penkala; Douglas D Bolgiano; José A López Journal: Arterioscler Thromb Vasc Biol Date: 2013-03-28 Impact factor: 8.311
Authors: E J Eichhorn; S E Demian; L G Alvarez; J E Willard; S Molina; L L Bartula; M D Prince; L R Inman; P A Grayburn; S I Myers Journal: J Am Coll Cardiol Date: 1992-03-01 Impact factor: 24.094