There are a number of potential causes of stroke due to the effects of recreational drugs. These are linked to their effects on the cardiovascular system including:
Increased risk of stroke linked to use of stimulant drugs. Use of these drugs can cause changes in blood pressure in the brain where a blood vessel may constrict or cause an aneurysm to rupture. Stimulant drugs can cause cause thromboembolism in a variety of different responses to drugs including Atrial Fibrillation or the drugs effect on platelet aggregation (stickiness).
Increased risk of stroke has been linked to use of IV and IM drugs administration. There are several potential causes for this including damage to the blood vessel/s used for IV injection or the introduction of infection leading to inflammation within the heart (endocarditis) and arrhythmias (including AF). Endocarditis is also linked to IM route where bacteria enter the blood stream either through direct contamination (needle) or intramuscular abscesses. For More information on bacterial endocarditis and risk of stroke visit the STARs Topic Loop
Increased risk of stroke has been linked to use of long term cannabis use. This is known to cause cardiomyopathy leading to heart failure and arrhythmias (Modi et al 2021). https://www.proquest.com/openview/2474f957ad6bd520e484fdfad8d43c0c/1?pq-origsite=gscholar&cbl=2045583
For more detailed information on recreational drugs visit: Talk to Frank
For more detailed information and support on drink and drugs for those under 25s visit: The Mix
Watch the video below to see an example of how a score calculator can be used to assess a patient’s risk. See the link underneath for an example of online calculators available to you.
On completion of this module you will be expected to have a critical understanding of the relevance and importance of secondary prevention in stroke patients.
You will learn:
Recognition of important underlying causes of stroke e.g. ischaemic due to cardiac embolism
Knowledge about risks of stroke after TIA and stroke and how one might present this to a patient e.g. relative risk, absolute risk
Understanding of the change of risk over time and the importance of this for starting treatments as early as possible
Understanding the indications for, and the effects of medications and surgical interventions in relation to secondary stroke prevention
Understanding the problem of poor adherence to medications
Advice on lifestyle modification and how best to influence / support lifestyle behaviour
More recently, other anticoagulants are being used in place of warfarin for patients who have had a stroke or TIA and in whom atrial fibrillation has been identified. These are referred to as Direct Oral Anticoagulants (DOACs):
DOACS do not need to be monitored in the same way as warfarin and have fewer drug interactions compared to warfarin.
DOACs work either by inhibiting factor Xa (these include drugs such as Apixaban, Edoxaban and Rivaroxaban) or by inhibiting Thrombin (these include drugs such as Dabigatran and Agatroban).
Clinically relevant bleeding may be lower with some of the DOACs compared to warfarin.
Specific drugs are required to reverse DOACs so it can sometimes be more difficult to reverse them if it is required urgently.
