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Author: Admin | 2025-04-28
Agents are known to cause endothelial cell damage, the authors postulate that a toxic effect to endothelial cells in the aortic wall was the underlying mechanism. However, the patient also had other risk factors, including hypercholesterolemia and tobacco smoking. Thus, a causal relationship between the cytotoxic drugs and the aortic dissection remains obscure, and, if the suggested underlying mechanism is correct, it is remarkable that no more reports are found in the literature. Numerous other drugs than those presented earlier in this review have the ability of causing hypertension. Consequently, these drugs might, at least in theory, increase the risk of aortic dissections. Common for these drugs is that there are no published case reports of aortic dissections related to their use. Whether the reason for the lack of such reports is that the relationship has not been recognised, or it is that the excess risk is so low that it can be considered negligible, is unknown. Drugs known to increase systemic blood pressure include sympathomimetic substances like adrenaline, noradrenaline, dopamine, metaraminol and phenylephrine, which might cause excessive elevations in blood pressure when the dose or, when given as an infusion, the rate of infusion, is not carefully controlled. Other drugs known to cause hypertension as an adverse drug reaction include non-steroidal antiinflammatory drugs (NSAIDs), ciclosporin and venlafaxine, just to mention a few. Moreover, monoamine oxidase inhibitors induce excessive hypertension when indirectly acting sympathomimetic drugs or tyramine-rich food or beverages are ingested concomitantly (Davies & Davies, 1998). 4.5. Illicit drugs 4.5.1. Cocaine The association between cocaine abuse and aortic dissection is well documented. In some case series of patients with aortic dissection the proportion caused by cocaine abuse is relatively high. For example, in a material from a US urban hospital, 14 of the 38 cases of aortic dissection registered between 1981 and 2000 (37 %) were related to cocaine use (Hsue et al., 2002). In another US study, (Singh et al., 2007), 13 of 46 cases (28 %) diagnosed between 1996 and 2005 were associated with cocaine. Finally, in a chart review for the period 1990-2006, 16 of 163
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