Effect of Hookah on Thrombosis

Hookah smoke—even short-term exposure—increases the likelihood of thrombosis and causes blood to clot more quickly, according to new data from a recent study conducted in a mouse model.1

The study was led by Fadi Khasawneh, B.Pharm, PhD, who is an associate professor in and chair of the Department of Pharmaceutical Sciences at the School of Pharmacy at The University of Texas at El Paso. This study was conducted in collaboration with his departmental colleague, Fatima Alshbool, PharmD, PhD, who is an assistant professor in the school of pharmacy.

Consultant360 caught up with Dr Khasawneh to find out more about these findings.

CON360: How did hookah and/or waterpipe smoke effect thrombogenesis in mice? 

Fadi Khasawneh: Exposure to hookah smoke was found to shorten the time that it takes for one of the major blood vessels to occlude, in a well-known thrombosis model in mice (Fecl3 carotid-artery injury induced thrombosis). This finding indicates that hookah smoke increases the risk of thrombosis

CON360: Did any of your findings surprise you? 

FK: We were not necessarily surprised that hookah was found to increase the risk of cardiovascular disease (thrombosis) but were perhaps surprised that this was the case even with short-term exposure (one week).

CON360: How might your findings translate into clinical practice? 

FK: We need to inform the public, specially individuals who are already under increased risk of cardiovascular/thrombotic disease, that smoking hookah or even perhaps being around someone who smokes hookah will increase or further increase their risk. Hookah is not a safe tobacco product. Also, many pregnant women switch or continue to smoke hookah not knowing that it is toxic, and we need to educate them.

CON360: In your opinion, do you think hookah should be treated like other tobacco products and regulated through the US Food and Drug Administration? 

FK: Yes, of course. Any and all forms of tobacco (including hookah) cause or can cause major adverse health effects to humans and need to be regulated. We need to have checks and balances to limit/prevent the access to hookah, including youth’s access, to prevent creating a new generation of tobacco users.

CON360: What are the next steps in your research? 

FK: Hopefully once/if we receive funding from the National Institutes of Health or other funding agencies, we can look at the mechanism by which hookah increases our risk of thrombotic disease so that we may come up with targeted therapy to manage its negative health effects. We are also interested in identifying the toxicants within hookah that are responsible for its adverse health effects.


  1. Alarabi AB, Karim ZA, Montes Ramirez JE, et al. Short-term exposure to waterpipe/hookah smoke triggers a hyperactive platelet activation state and increases the risk of thrombogenesis. Arterioscler Thromb Vasc Biol. 2020;40(2):335-349.