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Autopsy pathology of cocaine users from the Eastern district of London: a retrospective cohort study

¹ Wimbledon, London, UK
² The Coroners Court, Walthamstow, London, UK
³ Department of Histopathology, Bart’s and the London NHS Trust, The Royal London Hospital, Whitechapel, London, UK

Correspondence to:
Dr R Rajab, St Josephs Cottage, 135a Hartfield Road, Wimbledon, London SW19 3TJ, UK; ramzimarkrajab{at}yahoo.co.uk

Aim: To establish the most frequent pathological findings encountered at postmortem examination during the investigation of a fatality with a history of cocaine abuse.

Methods: Autopsied deaths investigated by the coroner for the Eastern district of London, between 2004 and 2007, in which the decedent had positive toxicology for cocaine were identified (n = 28). The autopsy records and histology of tissue taken at autopsy were retrieved and reviewed. Pathological findings (gross and microscopic, including cardiac, pulmonary, gastrointestinal, hepatobiliary, renal and neurological) were collated.

Results: The main pathological findings at autopsy occurring in this cohort (comprising predominantly men, mean age 31 years), were cardiovascular: left ventricular hypertrophy (46%), multifocal myocardial fibrosis (21%), coronary artery disease (29%), cerebrovascular disease (36%) and pulmonary oedema (71%). Hepatic steatosis (29%) and gastrointestinal haemorrhage (18%), due mostly to gastric erosions/ulceration, were also frequent findings.

Conclusions: During a coroner’s autopsy of a cocaine user, a thorough cardiac examination combined with cardiac tissue sampling for histology, are valuable investigations, which are most likely to help show pathology relevant to the cause of death.