A42-19 Storm in the Bloodstream: Cocaine Induced Thrombosis

Abstract Introduction Thrombotic storm is a rare, life-threatening condition defined by the rapid development of multiple thrombi in various vascular beds due to an underlying hypercoagulable state. It is typically associated with disorders like antiphospholipid syndrome, malignancy, and certain exogenous substances. Cocaine is well known for its vasoconstrictive and prothrombotic properties, often contributing to cardiovascular and cerebrovascular complications. However, its role as a direct trigger for thrombotic storm is rarely reported. We present a case of cocaine-induced thrombotic storm, highlighting the complexity and extent of our patient. Case Description A 77-year-old man with past medical history of Chronic Obstructive Pulmonary Disease, Active smoker, Coronary Artery Disease who was found in the emergency department (ED) with an acute left posterior temporal parietal lobe intraparenchymal hemorrhage and subarachnoid hemorrhage. Patient left against medical advice and returned two weeks later with a two-day history of progressive shortness of breath and dyspnea. During evaluation, the patient had one episode of syncope and was found with microcytic anemia. Toxicology revealed high cocaine levels after use on same day of admission. Given his symptoms, echocardiography was performed and showed new onset of heart failure with an ejection fraction of 25-30%, diastolic dysfunction, and a mobile right atrial thrombus (6 cm in length) extending through the tricuspid valve (Figure 1). After weighing risks and benefits, the patient was started on a heparin drip. Patient developed abdominal pain for which further imaging was ordered. An Abdominal/pelvic Computer Tomography (CT) with contrast revealed multiple thrombi in the superior mesenteric vein, celiac axis, portal vein, inferior vena cava, splenic infarcts, and extensive pulmonary embolism (Figure 1). On day 5 of anticoagulation, the patient developed acute leg pain with discoloration and diminished pulses and an acute limb ischemia was suspected. Imaging revealed severe stenosis at the tibioperoneal trunk with poor distal perfusion. Interventional radiology and vascular surgery were consulted. A right leg angiogram confirmed findings, and Rheolytic mechanical thrombectomy of the right superficial femoral artery with stent placement was performed. Conclusion This case highlights a rare but serious presentation of a thrombotic storm likely triggered by cocaine use. The extensive thrombotic involvement across multiple vascular beds shows the importance of early recognition, anticoagulation, and intervention to avoid further complications. Clinicians should be aware of cocaine’s potential and extensive thrombotic properties, especially in cardiac compromised patients. References: 1. COCAINE-INDUCED THROMBOTIC STORM. Sharma, ToishiRizkallah, Alain et al. CHEST, Volume 156, Issue 4, A627 - A628. doi: 10.1016/j.chest.2019.08.614 This abstract is funded by: None