Case Series of Cocaine-induced Pulmonary Embolism: An Unexpected Association or Emerging Trend? American Journal of Respiratory and Critical Care Medicine M.E. Faris, L. Sorour, T. Anagreh, H.H. Truong, R. Babiker, H. Friedman, and E. Saad. Case Series of Cocaine-induced Pulmonary Embolism: An Unexpected Association or Emerging Trend? [abstract]. Am J Respir Crit Care Med 2025;211:A4361. https://doi.org/10.1164/ajrccm.2025.211.Abstracts.A4361
Date
05/16/2025Abstract
Introduction: Cocaine use is well-known for its cardiovascular and pulmonary complications, including arterial vasospasm, but its role in venous thromboembolism (VTE), particularly pulmonary embolism (PE), is less understood and underreported. Limited data suggest that cocaine's prothrombotic effects such as vasoconstriction, enhanced platelet activation, and increased thrombin generation may contribute to VTE in young adults without traditional risk factors. With cocaine use remaining prevalent and linked to numerous emergency department visits, it is critical to recognize PE as a potential complication of cocaine use to facilitate prompt diagnosis and treatment. Case Presentations: We report four cases of acute PE with a history of recent cocaine use, and no other risk factors, all were admitted to Ascension Saint Francis Hospital with positive cocaine urine toxicology screen. Case 1: A 26-year-old female with obesity and psychiatric comorbidities presented with chest pain, diagnosed with bilateral PE and right heart strain. She improved after treatment with alteplase and heparin. Case 2: A 27-year-old male with polysubstance abuse and previous DVT on an IVC filter for 3 years, presented with shortness of breath, diagnosed with PE in the right lateral basal segment; he was discharged on rivaroxaban following enoxaparin treatment. Case 3: A 60-year-old female with a history of DVT and pulmonary hypertension presented with pleuritic chest pain and was found to have large bilateral PE with right heart strain. Case 4: A 53-year-old male with major depressive disorder and smoking history presented with hemoptysis and was diagnosed with multiple lobar emboli and pulmonary infarcts. All patients received anticoagulation, some received tPA and were managed in the ICU due to hemodynamic instability. Discussion: Cocaine use may predispose individuals to PE through mechanisms that create a hypercoagulable state and should be suspected as a cause in the absence of conventional PE risk factors. In these cases, imaging revealed extensive thrombotic burden, pulmonary infarcts, and signs of right heart strain, underscoring significant hemodynamic compromise in cocaine users. Positive cocaine urine toxicology screen served as crucial diagnostic clues, highlighting the importance of substance use history in unexplained PE, especially in younger patients. Acutely the patients will be treated with anticoagulation, but the patients' ongoing drug use complicates long-term management. This case series adds to limited research on cocaine-induced PE, suggesting it may represent an emerging trend. Increased clinical awareness and further research into the mechanisms and management of cocaine-induced PE could improve outcomes for this patient population.
Author List
ME Faris, L Sorour, T Anagreh, HH Truong, R Babiker, H Friedman, E SaadAuthor
Mohammed Elamin Faris MBBS Assistant Professor in the Medicine department at Medical College of WisconsinView Online
