Abstract Background and aims Stroke’s incidence among younger individuals is increasing, being substance use a growing cause. Cocaine has been identified as a risk factor for stroke. However, data on the clinical profile, acute management, and outcomes of cocaine-associated ischemic stroke in routine clinical practice remain limited; therefore, this study aims to address this gap. Methods We conducted a case–control study including consecutive patients with ischemic stroke who underwent urine cocaine testing at stroke onset at a comprehensive stroke center in Alicante between January 2023 and October 2025. Patients were classified as cocaine-positive or cocaine-negative based on toxicological screening. Results Among the 198 patients, 29 (14.64%) tested positive for cocaine. Age and sex distribution were similar between groups. Alcohol consumption (31.0% vs 6.5%, P 0.001) and tobacco use (79.3% vs 45.6%, P = 0.006) were more frequent in cocaine-positive patients, whereas cannabis use was less common. Baseline mRS scores were lower in the cocaine-positive group (P = 0.003). Cardiovascular risk factors, cardioembolic disease, and prior chronic treatments did not differ significantly between groups. Acute stenting was more frequently required in cocaine-positive patients (33.3% vs 20.9%, P = 0.023). Baseline and discharge NIHSS scores, as well as 3-month functional outcomes, were comparable. Treatment-related complications did not differ significantly. Arterial dissection was more frequent among cocaine-positive patients (P = 0.022). At discharge, anticoagulation was more common in cocaine-negative patients, whereas antiplatelet therapy and statin use were more frequent in cocaine-positive patients (overall P = 0.009). Conclusions These findings highlight the importance of targeted prevention strategies, increased awareness, and health education to reduce substance-related stroke risk. Conflict of interest Nothing to disclose.
Pardo et al. (Fri,) studied this question.