Influence of intranasal cocaine on plasma constituents associated with endogenous thrombosis and thrombolysis.
OBJECTIVE
As cocaine abuse has become widespread, catastrophic cocaine-associated cardiovascular events have been noted with increasing frequency. Although these incidents are thought to be caused by drug-induced vasoconstriction and/or arterial thrombosis, the influence of cocaine on the plasma constituents involved in endogenous thrombosis and thrombolysis has not been characterized.


METHODS
In 22 patients (8 men, 14 women, ages 32 to 62 years) undergoing cardiac catheterization, blood samples were procured before and 15 minutes after the administration of intranasal saline (n = 8, controls) or cocaine, 2 mg/kg (n = 14), and the plasma concentrations of fibrinogen, plasminogen, and lipoprotein(a), as well as tissue plasminogen activator activity and plasminogen activator inhibitor (PAI-1) activity, were measured.


RESULTS
No variable changed with the use of intranasal saline, whereas the use of cocaine resulted in an increase in PAI-1 activity (0.48 + 0.06 [mean + SD] nmol/L at baseline, 0.53 + 0.05 nmol/L after cocaine, P = 0.011).


CONCLUSIONS
Intranasal cocaine administration is associated with an increase in plasma PAI-1 activity. This may be important in recreational users of cocaine who experience vascular thrombosis.
Department of Internal Medicine (Cardiovascular Division), University of Texas Southwestern Medical Center 75235-9047.
D J
DJ
Moliterno
R A
RA
Lange
R D
RD
Gerard
J E
JE
Willard
C
C
Lackner
L D
LD
Hillis
D000281:Administration, Intranasal; D000328:Adult; D001777:Blood Coagulation / Q000187:drug effects*; D001779:Blood Coagulation Factors / Q000378:metabolism*; D016009:Chi-Square Distribution; D003042:Cocaine / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood; D008297:Male; D008875:Middle Aged; D010958:Plasminogen / Q000378:metabolism; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D010959:Tissue Plasminogen Activator / Q000097:blood
D001779:Blood Coagulation Factors; D017270:Lipoprotein(a); D017395:Plasminogen Activator Inhibitor 1; D005340:Fibrinogen; D010958:Plasminogen; D010959:Tissue Plasminogen Activator; D003042:Cocaine