title: Coronary thrombosis and marijuana smoking: a case report and narrative review of the literature.
abstract: We encountered evidence of myocardial infarction due to coronary thrombosis in an autopsy of an occasional marijuana smoker. These findings prompted us to perform a narrative review of the literature to determine when post-mortem toxicological tests may support a temporal relationship between marijuana smoking and cardiovascular disease. Toxicological examination showed the presence of Δ-9-tetrahydrocannabinol, its main metabolite and cannabinol in blood and urine. Quali-quantitative analysis revealed that Δ-9-tetrahydrocannabinol was taken within 2 h of the onset of cardiovascular symptoms, according to circumstantial data. Post-mortem toxicological results must take into account the degradation and post-mortem redistribution of analytes. However, for any inference about the specific cardiovascular triggering effect of Δ-9-tetrahydrocannabinol intake, we maintain that cannabinoid analysis in blood samples must be considered an essential requirement to estimate the time of last intake and avoid incomplete documentation. The literature, combined with the present case report, highlights an association between marijuana use and negative cardiovascular events, although few authors have supported their conclusions with toxicological results. Thus, additional research is needed.
authors.affiliation: Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Marchetti
authors.affiliation: Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy.
authors.forename: Angelico
authors.initials: A
authors.lastname: Spagnolo
authors.affiliation: Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy.
authors.forename: Valentino
authors.initials: V
authors.lastname: De Matteis
authors.affiliation: Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Filograna
authors.affiliation: Institute of Public Health, Section of Legal Medicine, Catholic University of Sacred Heart, L.go F. Vito, 1, 00168, Rome, Italy.
authors.forename: Nadia
authors.identifier: http://orcid.org/0000-0002-5949-4223
authors.initials: N
authors.lastname: De Giovanni
mesh_terms: D003328:Coronary Thrombosis / Q000097:blood / Q000150:complications* / Q000652:urine; D013759:Dronabinol / Q000097:blood / Q000652:urine; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000097:blood / Q000150:complications* / Q000652:urine; D008385:Marijuana Smoking / Q000009:adverse effects*; D008875:Middle Aged
chemical_list: D013759:Dronabinol
keywords: cardiovascular disease; forensic pathology; forensic sciences; marijuana smoking; toxicological analysis