Edible cannabis, clot link lacks data

Dear Dr. Roach: I am a 64-year-old male who considers himself active and healthy. In July 2020 I had a stroke, treated in a timely manner with a tissue plasminogen activator, and I have no residual effects. I will, about two to three times a month, take an edible cannabis to help me sleep or deal with a Crohn’s episode. My primary care provider does not like me taking any edible cannabis, as he says it is proven to lead to strokes and blood clots. What are your thoughts?

B.G.

Answer: The data linking cannabis to blood clots and strokes is mixed. There is evidence that smoked cannabis activates platelets, which is likely to increase clot risk. However, some studies of cannabis users showed increased clot and stroke risk only among those who smoked tobacco as well. I could not find any strong (or even marginal) data linking edible cannabis to an increased risk of stroke or blood clots. At the dose you are taking, I think it is very unlikely to do so.

Dear Dr. Roach: Is COVID-19 infection a cause of heart block? I recently had a complete heart block, tested positive in the ER for COVID-19, and was fitted with a permanent pacemaker later the same day. I’m 63, female, in good health except for a luckily nonsevere, 10-year diagnosis of Sjogren’s syndrome.

B.J.S.

Answer: Heart block is a condition where the electrical impulse from the top chambers of the heart to the bottom are completely blocked. I found case reports and a case series of people developing heart block while in the hospital with COVID-19 infection. In the case series, all three patients were severely ill and all cases of heart block recovered without need for pacemaker.

So while it is plausible the COVID-19 infection may have caused your heart block, this complication seems to be uncommon, and it may also be just that it happened to occur at the same time you had a case of COVID-19.

There are case reports of heart block developing in people with Sjogren’s syndrome. It’s possible that it was the Sjogren’s, not the COVID-19, that caused the permanent heart block.