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

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.

Marijuana Use Associated with Decreased Mortality in Trauma Patients

“…21 The association between marijuana use and major complications following trauma has been variable. [7][8][9] Stupinski et al found that THC exposure increases the risk of thromboembolic events. 8 Two studies performed by Singer (7) and Banks (9) reported marijuana use in trauma patients was associated with greater need for mechanical ventilation compared to non-marijuana users; however, both studies did not reveal an association between marijuana use and increased ventilator days.…”

“…Some previous studies on trauma patients have associated a pMS with increased need for mechanical ventilation and increased risk of thrombotic events. 7,8 Conversely, a recent statewide analysis demonstrated a pMS to be associated with decreased mortality in adult ICU trauma patients. 9 In support of this finding, multiple clinical studies have shown a pMS screen to have neuroprotective associations, including reduction of cognitive impairment and death following traumatic brain injury (TBI).…”

Cannabis‐based medicines and medical cannabis for patients with neuropathic pain and other pain disorders: Nationwide register‐based pharmacoepidemiologic comparison with propensity score matched controls

“…Previous studies have indicated that cannabis use may be a risk factor for thrombosis. It is thus uncertain whether this should be considered a true and unexpected finding, or whether it may be a case of selection in which physicians are less likely to prescribe CBM/MC to patients deemed to be at increased risk of thrombosis (Stupinski et al, 2020;Vakharia et al, 2020). It may also be that recreational users of cannabis are at increased risk of physical inactivity, eventually giving rise to venous thromboses, which is then not observed in a population using CBM/MC medicinally.…”

The Endocannabinoid System: A Potential Therapeutic Target for Coagulopathies

“…Stupinski et al [61] studied the impact of pre-injury chronic marijuana (THC) exposure on the development of thromboembolic complication (TEC) in adult trauma patients using a 2-year retrospective cohort analysis of the American College of Surgeons Trauma Quality and Improvement Program (ACS-TQIP) database. While trauma patients usually meet the criteria of Virchow's triad (hypercoagulability, stasis, and endothelial injury) and, thus, are more susceptible to developing TEC, it has been found that trauma patients who chronically consumed the phytocannabinoids THC before their injury independently exhibited higher rates of venous TEC, namely, DVT (6.6% vs. 1.8%, p = 0.02) and PE (2.2% vs. 0.2%, p = 0.04) compared to their matching control groups with no prior chronic exposure to THC.…”