Association Between Recent Cannabinoid Use and Acute Ischemic Stroke

ABSTRACT Objective: Studies that have analyzed the association between cannabis use and acute ischemic stroke have provided conflicting results. In this study, we aim to determine the association of recent cannabis use detected through urine drug screen among patients admitted with acute ischemic stroke. Methods: A retrospective observational study was performed utilizing the medical records database. All patients 18 years and older admitted from January 1, 2015 to December 31, 2017 who underwent urine toxicology testing on admission were included in the analysis. Multivariate logistic regression analysis was done to analyze independent association between recent cannabis use and acute ischemic stroke. Results: A total of 9,350 patients were determined to have undergone urine drug screen during admission and 18% (1,643) of this had a positive urine cannabis test. Unadjusted risk ratio showed a 50% decrease in risk of acute ischemic stroke among cannabis users (RR = 0.505, 95% CI 0.425 – 0.600). The effect was lost after adjusting for age, race, ethnicity, sickle cell disease, dyslipidemia, hypertension, obesity, diabetes mellitus, cigarette smoking, atrial fibrillation, and other cardiac conditions (OR 1.038, 95% CI 0.773-1.394). Conclusion: This is one of the few studies analyzing the association of recent cannabis use and acute ischemic stroke using admission urine toxicology test independent of polysubstance use. Even though our study has limitations, we did not find an independent association between recent cannabis use and the incidence of acute ischemic stroke. Further studies utilizing urine toxicology tests with larger sample size and including dosage of cannabis exposure should be done.