CLOTTING PROPENSITY IN TRAUMA PATIENTS ACCORDING TO MARIJUANA USE: A DESCRIPTIVE ANALYSIS

Objectives: Marijuana is the most readily consumed federally illegal drug in the United States yet understanding of its potential mediating effects on in-hospital complications remains incomplete. Past studies have focused on the impact of marijuana use on coagulation, some yielding inconclusive results and others reporting a propensity for hypercoagulability amongst marijuana users. We sought to elucidate whether marijuana use promotes hypercoagulable states among trauma patients. Our principal interest was with venous thromboembolism (VTE), a major contributor to morbidity and mortality in patients sustaining traumatic injury. We hypothesized that higher rates of VTE and bloodwork indicating an increased clotting proclivity would be observed in the marijuana positive (THC +) group versus the marijuana negative (THC -) group.

Methods: A retrospective, single institutional study was performed from January 2018 through June 2021 utilizing data from all patients presenting to our Level 1 Trauma Center as a trauma activation. Patients with a completed urine toxicology either negative or positive for only marijuana and/or clinically administered drugs were included. Analyses were performed using two-sample t-tests and chi-squared tests.

Results: 2,355 patients were identified that met inclusion criteria, 392 (16.6%) with positive marijuana toxicology and 1963 (84.4%) without. 28 (1.19%) of the total included patient population developed VTE during their hospitalizations. VTE developed more frequently in the marijuana-negative group (n=25, 1.27%) compared to the marijuana-positive group (n=3, 0.77%), but did not reach significance due to low overall occurrence of VTE (p=0.397). Patient thromboelastography (TEG) revealed a longer R time (4.9 v. 4.76, p=0.039) in the THC+ versus THC- group (albeit both within the normal range at our institution). Table 1 demonstrates characteristics of the two groups.

Conclusion: We found evidence contradictory to our hypothesis as our data showed a trend towards reduction in VTE frequency among marijuana users compared to nonusers. However, few VTE occurrences prevented definitive conclusions about a potential correlation between marijuana use and VTE development. Due to the association of marijuana with potentially confounding variables such as age, further studies examining larger populations with more VTE occurrences are needed to perform large scale linear regressions and control for more confounders. Studies that leverage statewide or nationwide trauma databases would be best suited to do so.