Cocaine in high concentrations inhibits platelet aggregation in vitro.

Complications of cocaine administration are acute vascular occlusions such as myocardial infarction and stroke. We have studied the influence of cocaine on platelet function in vitro. For that purpose, citrated blood from healthy volunteers was incubated with cocaine concentrations of 0 (control), 10, 100, 1000, 2500, and 10'000 µmol/l plasma. Platelet aggregation was measured in whole blood under high shear flow conditions with a platelet function analyzer PFA-100 using either epinephrine (EPI) or ADP as a platelet activator, as well as in non-flowing blood measuring the change of impedance after the addition of either collagen or ADP (Chronolog-700 Aggregometer). In addition, platelet aggregation was measured by the change in light transmission in platelet rich plasma containing the same cocaine concentrations (Chronolog-700). Platelet aggregation in flowing whole blood (PFA-100) was not affected by cocaine up to 1000 µmol/l, partially inhibited by 2500 µmol/l and completely inhibited by 10'000 µmol/l cocaine. In non-flowing blood, platelet aggregation was decreased already at cocaine concentrations of 1000 µmol/l with ADP and 2500 µmol/l with collagen as a platelet activator. In platelet-rich plasma, aggregation was partially inhibited by 1000 and 2500 µmol/l and completely inhibited by 10'000 µmol/l cocaine. We conclude that platelet aggregation is inhibited by cocaine in vitro. This occurs, however, at concentrations above those measurable in vivo. These observations make it very unlikely that a direct platelet activation plays a role in vascular events complicating cocaine consumption.

The passage of a hemodialysis filter affects hemorheology, red cell shape, and platelet aggregation.

We investigated the influence of the passage of a hemodialysis filter on red blood cells (RBCs), platelets, and hemorheological parameters. After one hour of hemodialysis, blood was drawn from 15 patients immediately ahead and behind the dialysis filter. RBCs were fixed for morphological analysis. Blood viscosity was measured with a Couette viscometer (LS-30, Contraves), RBC aggregation with a Myrenne aggregometer, platelet aggregation in flowing whole blood and in platelet rich plasma. The passage of the hemodialysis filter increased the hematocrit from 34.0 ± 3.8 to 44.6 ± 8.7% (p < 0.01). Discocytes decreased from 73 ± 9 to 60 ± 15%, while echinocytes/knizocytes were more abundant 24 ± 9% and 38 ± 15%, respectively, p < 0.01). Blood viscosity increased from 3.77 ± 0.52 to 6.75 ± 2.21 mPa.s (p < 0.01). The RBC aggregation index decreased from 25.8 ± 5.0 to 20.9 ± 5.6 (p < 0.05). These changes were less pronounced when the blood flow rate was reduced from 350 to 100 ml/min. Platelet aggregation was slightly increased in flowing whole blood, but decreased in platelet rich plasma. At the end of hemodialysis, a small increase in abnormally shaped RBCs, hematocrit, and whole blood viscosity persisted; platelet aggregation in flowing whole blood was reduced in all patients. We conclude that the passage of a hemodialysis filter induced RBC shape changes, increased the hematocrit, whole blood and plasma viscosity, decreased RBC aggregation, and affected platelet aggregation.

Cocaine induces a reversible stomatocytosis of red blood cells and increases blood viscosity.

Severe side effects of cocaine consumption are vasoocclusive events such as myocardial infarction and stroke. We have hypothesized that cocaine could affect red blood cells (RBCs) and alter the rheological behaviour of blood. Heparinized blood from healthy volunteers was incubated with a final hematocrit of 45% with increasing cocaine concentrations: 0, 10, 100, 1000, and 10'000 µmol/L plasma. Time dependence of the shape change was tested in phosphate buffered saline containing cocaine. RBCs were fixed in 1% glutaraldehyde for morphological analysis. Blood viscosity was measured with a Couette Viscometer (Contraves LS 30) at 37°C and a shear rate of 69.5 s⁻¹. RBC aggregation was assessed with a Myrenne aggregometer. Cocaine induced a dose-dependent stomatocytic shape transformation of RBCs, which was more pronounced in buffer than in plasma (plasma protein binding of the drug). Stomatocytosis occurs when a drug intercalates preferentially in the inner half of the membrane lipid bilayer. It was a time-dependent process with two components, an almost instant shape change occurring within 1 s, followed by a gradual further shape change during 10 min. Stomatocytosis was reversible by resuspension of the RBCs in cocaine-free buffer. This stomatocytic shape change increased whole blood viscosity at high shear rate from 5.69±0.31 mPa.s to 6.39±0.34 mPa.s for control and 10'000 µmol/L cocaine, respectively (p<0.01). RBC aggregation was not affected by the shape change. These effects occurred at a cocaine concentration, which is several-fold above those measured in vivo. Therefore, it is unlikely that hemorheological factors are involved in vascular events after cocaine consumption.