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

Reference:

Chang TR, Kowalski RG, Caserta F, et al. Impact of acute cocaine use on aneurysmal subarachnoid hemorrhage. Stroke. 2013;44(7):1825–1829.