Marijuana and thromboembolic events in geriatric trauma patients: The cannabinoids clots correlation!

Samer Asmar; Adam Nelson; Tanya Anand; Ahmad Hammad; Omar Obaid; Michael Ditillo; Tawab Saljuqi; Andrew Tang; Bellal Joseph

doi:10.1016/j.amjsurg.2021.07.036

Marijuana and thromboembolic events in geriatric trauma patients: The cannabinoids clots correlation!

Am J Surg. 2022 Apr;223(4):798-803. doi: 10.1016/j.amjsurg.2021.07.036. Epub 2021 Jul 28.

Authors

Samer Asmar¹, Adam Nelson², Tanya Anand³, Ahmad Hammad⁴, Omar Obaid⁵, Michael Ditillo⁶, Tawab Saljuqi⁷, Andrew Tang⁸, Bellal Joseph⁹

Affiliations

¹ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: samerasmar94@surgery.arizona.edu.
² Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: adamcnelson@email.arizona.edu.
³ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: tanyaanand@email.arizona.edu.
⁴ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: ahmadhammad2@arizona.edu.
⁵ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: omarobaid@arizona.edu.
⁶ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: mfditillo@surgery.arizona.edu.
⁷ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: tsaljuqi@email.arizona.edu.
⁸ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: atang@surgery.arizona.edu.
⁹ Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: bjoseph@surgery.arizona.edu.

PMID: 34334193
DOI: 10.1016/j.amjsurg.2021.07.036

Abstract

Background: Tetrahydrocannabinol (THC) can alter the coagulation cascade resulting in hypercoagulability. The aim of our study is to evaluate the impact of THC use on thromboembolic complications (TEC) in geriatric trauma patients (GTP).

Methods: This is a 2017 analysis of the TQIP database including all GTP (age ≥65 years). Patients were stratified based on THC use. Propensity score matching (1:2 ratio) was performed.

Results: A total of 2,835 patients were matched (THC+: 945 and THC-: 1,890). Mean age was 70 ± 6 years, 94% sustained blunt injuries, and median ISS was 22[12-27]. Sixty-two percent of patients received thromboprophylaxis, with median time to initiation of 27 h from admission. Overall, the rate of TEC was 2.1% and mortality was 6.0%. THC + patients had significantly higher rates of TEC compared to THC- patients (3.0% vs. 1.7%; p = 0.01). Rates of DVT (2.2% vs 0.6%, p < 0.01) and PE (1.4% vs 0.4%, p < 0.01) were higher in the THC + group.

Conclusion: THC exposure increases the risk of TEC in GTP. Incorporation of THC use into risk assessment protocols merits serious consideration in GTP.

Keywords: Geriatrics; Marijuana; Thromboembolic complications; Trauma.

MeSH terms

Aged
Anticoagulants / therapeutic use
Cannabinoids*
Cannabis*
Dronabinol
Guanosine Triphosphate
Humans
Middle Aged
Retrospective Studies
Thrombosis*
Venous Thromboembolism* / epidemiology
Venous Thromboembolism* / etiology
Venous Thromboembolism* / prevention & control

Substances

Anticoagulants
Cannabinoids
Dronabinol
Guanosine Triphosphate