title: Cocaine-induced coronary thrombosis: what is the optimal treatment strategy.
abstract: Arterial thrombosis and especially coronary thrombosis are known complications of cocaine abuse. We report three cases of severe life-threatening coronary arterial thrombosis manifesting as acute coronary syndromes. Thrombosis occurred predominantly in the proximal coronary tree with spontaneous distal embolization. The thrombotic occlusions were frequently not superimposed on flow-limiting atherosclerotic lesions. Treatment of these patients with thrombolytic, antithrombotic and anti-platelet therapy resulted in thrombus and symptom resolution. While stenting these vessels can be successfully executed and may be required in some cases of ST-elevation myocardial infarction, it may expose these patients to the risk of stent thrombosis, which is reported to be significantly higher than the risk of the general population.
authors.affiliation: University Hospital and New Jersey Medical School University of Medicine and Dentistry, Newark, NJ 07101, USA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Rusovici
authors.forename: Santosh
authors.initials: S
authors.lastname: Varkey
authors.forename: Qaisra
authors.initials: Q
authors.lastname: Saeed
authors.forename: Marc
authors.initials: M
authors.lastname: Klapholz
authors.forename: Bunyad
authors.initials: B
authors.lastname: Haider
authors.forename: Edo
authors.initials: E
authors.lastname: Kaluski
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D000328:Adult; D019970:Cocaine-Related Disorders / Q000150:complications*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D015607:Stents; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors