EUH Hunt Conference: Is there a direct relationship between cocaine use and aortic dissection?

The Bottom Line: Yes. Cocaine serves as both a predisposing factor to aortic dissection due to its effect on aortic connective tissue and as a precipitating factor due to its propensity to produce abrupt and severe hypertension.

References: Dean JH, Woznicki EM, O’Gara P, Montgomery DG, et al. Cocaine-related aortic dissection: Lessons from the International Registry of Acute Aortic Dissection. American Journal of Medicine, Sept 2014; 127(9):878-885. doi:10.1016/j.amjmed.2014.05.005.

Singh A, Khaja A, Alpert MA. Cocaine and aortic dissection. Vascular Medicine, Apr 2010; 15(2):127-133. doi:10.1177/1358863X09358749.

Summary: Acute aortic dissection associated with cocaine use is rare and has been reported predominantly as single cases or in small patient cohorts. While similarities exist in the clinical features and diagnostic methods between cocaine-related aortic dissection and aortic dissection unrelated to cocaine use, there are important differences in management between these two syndromes which are rooted in the pharmacology and physiology of cocaine (Singh et al, 2010).  According to the International Registry of Acute Aortic Dissection, cocaine use is implicated in 1.8% of patients with acute aortic dissection. The typical patient is relatively young and has the additional risk factors of hypertension and tobacco use. In-hospital mortality for those with cocaine-related type A dissection is lower than for those with non cocaine-related dissection, likely due to the younger age at presentation (Dean et al, 2014).

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