Perioperative MI Risk 46% Higher in Cannabis Users per 44k-Patient Review

The review combined retrospective data from surgical registries and electronic health records to compare cardiovascular and thrombotic outcomes in cannabis users versus non-users undergoing procedures under anesthesia. Cannabis exposure was identified via patient self-report or ICD codes; primary endpoints included myocardial infarction, stroke, venous thromboembolism, and mortality within 30 days. No adjustment for potency, route, or recency of use was possible across datasets.

THC-driven increases in heart rate, blood pressure, and myocardial oxygen demand plus potential coronary vasospasm plausibly explain the elevated MI signal during the hemodynamic stress of anesthesia. The concurrent 22% reduction in venous thromboembolism may reflect cannabis effects on platelet aggregation or inflammation, yet residual confounding by indication or unmeasured comorbidities cannot be excluded. Prior large observational cohorts, including Mittleman et al. in Circulation 2001 and Desai et al. in JACC 2022, have shown similar directional associations outside the surgical window.

Because the data derive from non-randomized sources without dose-response or temporal granularity, causality remains unproven. Next steps require prospective perioperative registries that capture THC concentration, timing of last use, and standardized troponin surveillance to test whether risk is modifiable by temporary cessation protocols.

Patients should disclose use so anesthesiologists can intensify hemodynamic monitoring and consider delaying elective cases in heavy users.