Cocaine and Ischemic or Hemorrhagic Stroke: A Systematic Review and Meta-Analysis of Clinical Evidence

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Aug 26

PMID 37629248

Authors

Luis F Rendon

Stephanie Malta

Jacob Leung

Rafael Badenes

Ala Nozari

Federico Bilotta

Affiliations

Soon will be listed here.

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, < 0.001). The odds of mortality (OR = 1.77, = 0.0021), vasospasm (OR = 2.25, = 0.0037), and seizures (OR = 1.61, < 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.

Citing Articles

Severe Cardiopulmonary Complications and Stroke in a Patient With HIV and Chronic Substance Abuse: A Case Report.

Mansha W, Eftekharzadeh P, Ahmed S Cureus. 2025; 16(12):e75070.

PMID: 39759678 PMC: 11695807. DOI: 10.7759/cureus.75070.

Dynamic alterations in gene co-expression networks and gene-transcript associations characterize co-morbidities in cocaine use disorder.

Nwaneshiudu C, Girdhar K, Kleopoulos S, Fullard J, Butelman E, Parvaz M bioRxiv. 2024; .

PMID: 39026764 PMC: 11257536. DOI: 10.1101/2024.07.10.602908.

References

Qureshi A, Akbar M, Czander E, Safdar K, Janssen R, Frankel M . Crack cocaine use and stroke in young patients. Neurology. 1997; 48(2):341-5. DOI: 10.1212/wnl.48.2.341. View

Martin-Schild S, Albright K, Misra V, Philip M, Barreto A, Hallevi H . Intravenous tissue plasminogen activator in patients with cocaine-associated acute ischemic stroke. Stroke. 2009; 40(11):3635-7. PMC: 3426832. DOI: 10.1161/STROKEAHA.109.559823. View

Tormoehlen L, Blatsioris A, Moser E, Carter R, Stevenson A, Ofner S . Disparities and guideline adherence in drugs of abuse screening in intracerebral hemorrhage. Neurology. 2016; 88(3):252-258. PMC: 5272789. DOI: 10.1212/WNL.0000000000003505. View

Simpson Jr R, Fischer D, Narayan R, Cech D, Robertson C . Intravenous cocaine abuse and subarachnoid haemorrhage: effect on outcome. Br J Neurosurg. 1990; 4(1):27-30. DOI: 10.3109/02688699009000678. View

Liberato A, Xu J, Montes D, Heit J, Barnaure I, Maza N . Multivariable analysis on factors associated with aneurysm rupture in patients with multiple intracranial aneurysms. Emerg Radiol. 2020; 27(5):487-494. DOI: 10.1007/s10140-020-01790-5. View

Bachi K, Mani V, Jeyachandran D, Fayad Z, Goldstein R, Alia-Klein N . Vascular disease in cocaine addiction. Atherosclerosis. 2017; 262:154-162. PMC: 5757372. DOI: 10.1016/j.atherosclerosis.2017.03.019. View

Qureshi A, Mohammad Y, Suri M, Braimah J, Janardhan V, Guterman L . Cocaine use and hypertension are major risk factors for intracerebral hemorrhage in young African Americans. Ethn Dis. 2001; 11(2):311-9. View

Chang T, Kowalski R, Caserta F, Carhuapoma J, Tamargo R, Naval N . Impact of acute cocaine use on aneurysmal subarachnoid hemorrhage. Stroke. 2013; 44(7):1825-9. DOI: 10.1161/STROKEAHA.111.000749. View

Jabbarli R, Dinger T, Oppong M, Pierscianek D, Dammann P, Wrede K . Risk Factors for and Clinical Consequences of Multiple Intracranial Aneurysms: A Systematic Review and Meta-Analysis. Stroke. 2018; 49(4):848-855. DOI: 10.1161/STROKEAHA.117.020342. View

10.

Nolte K, Brass L, Fletterick C . Intracranial hemorrhage associated with cocaine abuse: a prospective autopsy study. Neurology. 1996; 46(5):1291-6. DOI: 10.1212/wnl.46.5.1291. View

11.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gotzsche P, Ioannidis J . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009; 6(7):e1000100. PMC: 2707010. DOI: 10.1371/journal.pmed.1000100. View

12.

Peacock A, Tran L, Larney S, Stockings E, Santo Jr T, Jones H . All-cause and cause-specific mortality among people with regular or problematic cocaine use: a systematic review and meta-analysis. Addiction. 2020; 116(4):725-742. PMC: 7914269. DOI: 10.1111/add.15239. View

13.

Fehnel C, Ayres A, Rost N . Socioeconomic status does not predict cocaine use among ischemic stroke patients: A nested case-control study. JRSM Cardiovasc Dis. 2014; 3:2048004014539666. PMC: 4157493. DOI: 10.1177/2048004014539666. View

14.

Chang T, Kowalski R, Carhuapoma J, Tamargo R, Naval N . Cocaine use as an independent predictor of seizures after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2015; 124(3):730-5. DOI: 10.3171/2015.2.JNS142856. View

15.

Kedia S, Sell M, Relyea G . Mono- versus polydrug abuse patterns among publicly funded clients. Subst Abuse Treat Prev Policy. 2007; 2:33. PMC: 2211290. DOI: 10.1186/1747-597X-2-33. View

16.

Carrillo X, Curos A, Muga R, Serra J, Sanvisens A, Bayes-Genis A . Acute coronary syndrome and cocaine use: 8-year prevalence and inhospital outcomes. Eur Heart J. 2011; 32(10):1244-50. DOI: 10.1093/eurheartj/ehq504. View

17.

Bajwa A, Silliman S, Cury J, Seeram V, Shujaat A, Usman F . Characteristics and outcomes of cocaine-related spontaneous intracerebral hemorrhages. ISRN Neurol. 2013; 2013:124390. PMC: 3603298. DOI: 10.1155/2013/124390. View

18.

Nanda A, Vannemreddy P, Willis B, Kelley R . Stroke in the young: relationship of active cocaine use with stroke mechanism and outcome. Acta Neurochir Suppl. 2006; 96:91-6. DOI: 10.1007/3-211-30714-1_22. View

19.

Kibayashi K, MASTRI A, Hirsch C . Cocaine induced intracerebral hemorrhage: analysis of predisposing factors and mechanisms causing hemorrhagic strokes. Hum Pathol. 1995; 26(6):659-63. DOI: 10.1016/0046-8177(95)90172-8. View

20.

Alaraj A, Wallace A, Mander N, Aletich V, Charbel F, Amin-Hanjani S . Effect of acute cocaine use on vasospasm and outcome in aneurysmal subarachnoid hemorrhage. World Neurosurg. 2010; 73(4):357-60. DOI: 10.1016/j.wneu.2010.01.011. View