American Journal of Emergency Medicine xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Correspondence
Effect of regular marijuana smoking on the platelet functions To the Editor, The article by Velibey et al [1] published online ahead of print, about the 27-year-old man who had acute myocardial infarction, after marijuana smoking is of interest for emergency physicians confronted by the epidemic of illicit drug, and emphasizes the need for a high index of suspicion for underlying acute myocardial infarction in such young patients, so that this diagnosis can be made expeditiously. Marijuana (extracted from the resin of Cannabis sativa) is the second most widely smoked substance after tobacco in the United States [2]. Tetrahydrocannabinol, the active ingredient in marijuana, affects the various systems of the human body through endocannabinoid receptors [3]. Activated platelets play an essential role in the pathogenesis of atherothrombotic events. As a result, intensive antiplatelet therapies are a key pharmacological component in the management of myocardial ischemia and infarction [4]. Many chemicals and toxic substances cause disruption of structural and functional integrity of platelets and associated with secondary platelet dysfunction [5]. Potential mechanisms underlying the effect of regular marijuana smoking on the platelet functions and thrombus formation are not clear, subject to debate, and indeed complex. Deusch et al [6] demonstrated that tetrahydrocannabinol activates platelets as determined by enhanced glycoprotein IIb-IIIa and P-selectin expression. On the other hand, recently, De Angelis et al [7] investigated the influence of C sativa consumption by human volunteers on platelet activation. They found that collagen-induced platelet aggregation and aggregate formation on immobilized collagen under flow were impaired in whole blood of donors. The authors concluded that endocannabinoid receptor agonists, such as anandamide, reduce platelet activation and aggregate formation both in vitro and ex vivo after C sativa consumption. Consequently, as emphasized by the authors, patients presenting to the emergency department with marijuana abuse should be monitored for potential major complications.
Yalcin Golcuk, MD⁎ Department of Emergency Medicine, Faculty of Medicine, Celal Bayar University, Manisa, Turkey ⁎Corresponding author at: Celal Bayar University, Faculty of Medicine Department of Emergency Medicine, Manisa Turkey Tel.: +90 236 4444228; fax: +90 236 2338040 E-mail address: [email protected] Burcu Golcuk, MD Department of Clinical Biochemistry, Merkez Efendi State Hospital Manisa, Turkey Semih Sozen, MD Department of Emergency Medicine, Sivas State Hospital Sivas, Turkey
http://dx.doi.org/10.1016/j.ajem.2015.02.012 References [1] Velibey Y, Sahin S, Tanık O, Keskin M, Bolca O, Eren M. Acute myocardial infarction due to marijuana smoking in a young man: guilty should not be underestimated. Am J Emerg Med 2015. http://dx.doi.org/10.1016/j.ajem.2015.01.032. [2] Moore BA, Auguston EM, Moser RP, Budney AJ. Respiratory effects of marijuana and tobacco use in a U.S. sample. J Gen Intern Med 2005;20:33–7. [3] Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers 2007;4: 1770–804. [4] Clappers N, Brouwer MA, Verheugt FW. Antiplatelet treatment for coronary heart disease. Heart 2007;93:258–65. [5] Ghoshal K, Bhattacharyya M. Overview of platelet physiology: its hemostatic and nonhemostatic role in disease pathogenesis. ScientificWorldJournal 2014;3:781857. [6] Deusch E, Kress HG, Kraft B, Kozek-Langenecker SA. The procoagulatory effects of delta-9-tetrahydrocannabinol in human platelets. Anesth Analg 2004;99:1127–30. [7] De Angelis V, Koekman AC, Weeterings C, Roest M, de Groot PG, Herczenik E, et al. Endocannabinoids control platelet activation and limit aggregate formation under flow. PLoS One 2014;9(9):e108282.
0735-6757/© 2015 Elsevier Inc. All rights reserved.
Please cite this article as: Golcuk Y, et al, Effect of regular marijuana smoking on the platelet functions, Am J Emerg Med (2015), http://dx.doi.org/ 10.1016/j.ajem.2015.02.012
Contents lists available at ScienceDirect
American Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/ajem
Correspondence
Effect of regular marijuana smoking on the platelet functions To the Editor, The article by Velibey et al [1] published online ahead of print, about the 27-year-old man who had acute myocardial infarction, after marijuana smoking is of interest for emergency physicians confronted by the epidemic of illicit drug, and emphasizes the need for a high index of suspicion for underlying acute myocardial infarction in such young patients, so that this diagnosis can be made expeditiously. Marijuana (extracted from the resin of Cannabis sativa) is the second most widely smoked substance after tobacco in the United States [2]. Tetrahydrocannabinol, the active ingredient in marijuana, affects the various systems of the human body through endocannabinoid receptors [3]. Activated platelets play an essential role in the pathogenesis of atherothrombotic events. As a result, intensive antiplatelet therapies are a key pharmacological component in the management of myocardial ischemia and infarction [4]. Many chemicals and toxic substances cause disruption of structural and functional integrity of platelets and associated with secondary platelet dysfunction [5]. Potential mechanisms underlying the effect of regular marijuana smoking on the platelet functions and thrombus formation are not clear, subject to debate, and indeed complex. Deusch et al [6] demonstrated that tetrahydrocannabinol activates platelets as determined by enhanced glycoprotein IIb-IIIa and P-selectin expression. On the other hand, recently, De Angelis et al [7] investigated the influence of C sativa consumption by human volunteers on platelet activation. They found that collagen-induced platelet aggregation and aggregate formation on immobilized collagen under flow were impaired in whole blood of donors. The authors concluded that endocannabinoid receptor agonists, such as anandamide, reduce platelet activation and aggregate formation both in vitro and ex vivo after C sativa consumption. Consequently, as emphasized by the authors, patients presenting to the emergency department with marijuana abuse should be monitored for potential major complications.
Yalcin Golcuk, MD⁎ Department of Emergency Medicine, Faculty of Medicine, Celal Bayar University, Manisa, Turkey ⁎Corresponding author at: Celal Bayar University, Faculty of Medicine Department of Emergency Medicine, Manisa Turkey Tel.: +90 236 4444228; fax: +90 236 2338040 E-mail address: [email protected] Burcu Golcuk, MD Department of Clinical Biochemistry, Merkez Efendi State Hospital Manisa, Turkey Semih Sozen, MD Department of Emergency Medicine, Sivas State Hospital Sivas, Turkey
http://dx.doi.org/10.1016/j.ajem.2015.02.012 References [1] Velibey Y, Sahin S, Tanık O, Keskin M, Bolca O, Eren M. Acute myocardial infarction due to marijuana smoking in a young man: guilty should not be underestimated. Am J Emerg Med 2015. http://dx.doi.org/10.1016/j.ajem.2015.01.032. [2] Moore BA, Auguston EM, Moser RP, Budney AJ. Respiratory effects of marijuana and tobacco use in a U.S. sample. J Gen Intern Med 2005;20:33–7. [3] Huestis MA. Human cannabinoid pharmacokinetics. Chem Biodivers 2007;4: 1770–804. [4] Clappers N, Brouwer MA, Verheugt FW. Antiplatelet treatment for coronary heart disease. Heart 2007;93:258–65. [5] Ghoshal K, Bhattacharyya M. Overview of platelet physiology: its hemostatic and nonhemostatic role in disease pathogenesis. ScientificWorldJournal 2014;3:781857. [6] Deusch E, Kress HG, Kraft B, Kozek-Langenecker SA. The procoagulatory effects of delta-9-tetrahydrocannabinol in human platelets. Anesth Analg 2004;99:1127–30. [7] De Angelis V, Koekman AC, Weeterings C, Roest M, de Groot PG, Herczenik E, et al. Endocannabinoids control platelet activation and limit aggregate formation under flow. PLoS One 2014;9(9):e108282.
0735-6757/© 2015 Elsevier Inc. All rights reserved.
Please cite this article as: Golcuk Y, et al, Effect of regular marijuana smoking on the platelet functions, Am J Emerg Med (2015), http://dx.doi.org/ 10.1016/j.ajem.2015.02.012
