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Letters |15 March 1995

Smoking while Wearing a Nicotine Patch

James G. Warner Jr; William C. Little

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • Institute for Prevention of Cardiovascular Disease, New England Deaconess Hospital, Boston, MA 02215. The Bowman Gray School of Medicine, Winston-Salem, NC 27157.
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IN RESPONSE:
We appreciate Dr. Mittleman's comments and agree with his summary of the limitations of interpreting causation from a single clinical observation.
In addition to our patient [1], several other patients whose cardiac events were temporally related to smoking while wearing a nicotine patch have been described [2]. The combination of smoking and transdermal nicotine can produce high nicotine levels [3, 4]. Because nicotine produces vasoconstriction, catecholamine release, and platelet aggregation, it may also trigger plaque rupture, leading to the formation of an occlusive thrombus and resulting in myocardial infarction. Although our observation and physiologic plausibility do not establish that smoking while wearing a nicotine patch can trigger cardiac events, we believe that patients with established coronary artery disease should avoid nicotine from any source. Further, all users of nicotine patches should be warned of the additional potential risks associated with smoking.
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Warner Jr JG, Little WC. Smoking while Wearing a Nicotine Patch. Ann Intern Med. ;122:476–477. doi: 10.7326/0003-4819-122-6-199503150-00023

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Published: Ann Intern Med. 1995;122(6):476-477.

DOI: 10.7326/0003-4819-122-6-199503150-00023

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Print ISSN: 0003-4819 | Online ISSN: 1539-3704

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