Increased incidence of stent thrombosis in patients with cocaine use

Introduction: Coronary stent thrombosis is a rare occurrence in the era of dual-antiplatelet therapy. It is not known whether patients who use cocaine have a higher risk of thrombosis following coronary stent placement. Methods: We studied 247 consecutive patients who underwent coronary stent placement at an inner-city hospital. Results: Twelve patients (4.9%) were actively using cocaine at the time of PCI. Of these twelve patients, four patients presented with stent thrombosis (33%) at a mean of 51 +/- 40 days (median 45 days), after the index revascularization procedure. Only 2 of the 235 patients without documented cocaine use (0.85%) had stent thrombosis during the same period (P < 0.0001). Conclusion: The patients who actively use cocaine have a markedly higher risk of stent thrombosis when compared with patients without a documented history of cocaine use. We discuss various factors that potentially predispose cocaine users to stent thrombosis. (C) 2007 Wiley-Liss, Inc.