the Ischemic stroke in young adults and cocaine use: A critical synthesis of the evidence

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Abstract
Introduction: Research suggests an association between cocaine use and an increased risk of ische­mic stroke, with a more pronounced impact among young adults. Despite strong biological plausi­bility and growing epidemiological documentation, the magnitude of the risk attributable to cocaine use in this population has not yet been fully established. Therefore, the objective of this study was to analyze the published evidence regarding the association between cocaine use and the occurrence of ischemic stroke in young adults. Materials and methods: An integrative review was conducted in accordance with PRISMA recom­mendations. The literature search was performed in August 2024 in the MEDLINE/PubMed, LI­LACS, Scopus, and Web of Science databases. Studies investigating the relationship between co­caine use and ischemic stroke in adolescents or young adults were included. Methodological quality was classified according to Melnyk and colleagues’ hierarchy of evidence levels, and thematic analy­sis followed Bardin’s framework. Results: Thirteen studies met the eligibility criteria. The findings indicate an association between cocaine use and an increased risk of ischemic stroke in young adults, particularly following acute exposure. Reported mechanisms include cerebral vasospasm, endothelial dysfunction, platelet acti­vation, and hemodynamic alterations. Discussion: The amplification of risk following acute exposure and the concomitant use of multiple substances corroborate findings from previous investigations. Conclusion: The available evidence suggests that cocaine use constitutes a risk factor for ischemic stroke in young adults. The predominance of observational studies underscores the need for more rigorous investigations to achieve more precise estimates of attributable risk.

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