Subarachnoid Hemorrhage after Cocaine Use Associated with Aneurysm Re-Rupture and Death
Cocaine use has been linked to aneurysmal subarachnoid hemorrhage (aSAH). This retrospective review of all patients admitted with aSAH to Johns Hopkins medical institutions over 2 decades sought to examine the impact of recent cocaine use on initial presentation, complications, and outcomes. Of the 1134 aSAH patients, 142 (13%) had recent cocaine exposure identified by a urine toxicology test or self-reported cocaine use within 72 hours. Compared to those without known recent cocaine use:
- People with cocaine use were younger (mean age 49 versus 53).
- Aneurysm re-rupture incidence was higher among people with cocaine use (8% versus 3%).
- In-hospital mortality for people with cocaine use was 3 times higher in multivariable analysis and mortality rates remained higher even after exclusion of patients from both cohorts with aneurysm re-rupture (25% versus 16%).
Comments:Cocaine use is associated with higher in-hospital mortality after aSAH, likely due in part to higher rates of aneurysm re-rupture. Patients presenting with aSAH who have recently used cocaine may require closer monitoring. Efforts to reduce risk for aneurysm re-rupture, such as blood pressure control or even antifibrinolytic medications, warrant further investigation. Nadia Fairbairn, MD †, and Richard Saitz, MD, MPH
†Contributing Editorial Intern and Resident in Internal Medicine, University of British Columbia, Vancouver, Canada.