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Letters |15 March 1995

Smoking while Wearing a Nicotine Patch

James G. Warner Jr; William C. Little

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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...
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Warner Jr JG, Little WC. Smoking while Wearing a Nicotine Patch. Ann Intern Med. 1995;122:476–477. doi: https://doi.org/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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