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Case reports link cannabis, cerebrovascular events
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In a review of 34 case reports on 64 patients, most supported a causal link between cannabis consumption and cerebrovascular events, according to data published in Stroke.
“An increasing number of case reports link cannabis consumption to cerebrovascular events. Yet, these case reports have not been scrutinized using criteria for causal inference,” wrote Daniel G. Hackam, MD, PhD, FRCPC, from the division of clinical pharmacology at Western University in London, Ontario, Canada.
Hackam evaluated the following causality criteria:
- temporality, defined as stroke or transient ischemic attack within 24 hours of cannabis consumption;
- adequacy of the stroke workup, with a detailed evaluation including CT angiography, magnetic resonance angiography or catheter angiography in addition to parenchymal imaging, blood tests for thrombophilia and vasculitis and a cardiac assessment involving ECG monitoring and echocardiography;
- the effects of rechallenge; and
- presence of potential risk factors other than cannabis use that could be related to a cerebrovascular event.
Eighty percent of patients in the case reports were men, and the median patient age was 32 years.
Eighty-one percent of reports indicated a temporal relationship between the index cerebrovascular event and exposure to cannabis. The evaluation was considered “sufficiently comprehensive” to exclude other potential causes for stroke in 70% of cases. Twenty-two percent of patients had a recurrent stroke after re-exposure to cannabis after the index event.
Concomitant risk factors for stroke were observed in half of patients; the most frequent risk factors included tobacco use (34%) and alcohol consumption (11%).
Hackam concluded that the available case reports were “relatively robust.” However, he said a prospective epidemiological study is necessary to prove a causal relationship between cannabis use and stroke.
“Overall, however, it seems clear that physiological, clinical and epidemiological data converge on increased stroke risk from cannabis exposure,” he wrote. “Heightened clinician awareness of this association, particularly in the treatment of young adults, is necessary for preventing recurrent events from future re-exposure to cannabis.” – by Adam Taliercio
Disclosure: Hackam reports no relevant financial disclosures.
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