Effect of morphine use on oral P2Y12 platelet inhibitors in acute myocardial infarction: Meta-analysis

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dc.contributor.authorVaidya, Gaurang Nandkishoren_US
dc.contributor.authorKhan, Abduren_US
dc.contributor.authorGhafghazi, Shahaben_US
dc.date.accessioned2020-01-02T06:40:28Z
dc.date.available2020-01-02T06:40:28Z
dc.date.issued2019-03
dc.description.abstractBackground Morphine is the recommended analgesic in acute myocardial infarction (AMI). This recommendation has come under scrutiny because of possible slow uptake of oral antiplatelet agents. Objective We performed a meta-analysis of all available studies in AMI patients treated with prasugrel or ticagrelor (P2Y12 inhibitors) that reported use of morphine prior to loading the antiplatelet agents to critically assess the safety of co-administration of morphine and the newer P2Y12 inhibitors. Methods Several sources were searched from inception to December 2017 with inclusion of eight studies, largely observational. Mean difference (MD) was calculated for continuous variables, and standardized mean difference (SMD) for platelet function was assessed by the various platelet assays, 2 h after the loading dose of oral P2Y12 inhibitors. Results Higher platelet activity was noted among morphine group [SMD = 0.8, 95% confidence interval (CI) = 0.4–1.1, p < 0.01]. Morphine use caused higher odds of “high residual platelet reactivity” at 2 h (odds = 3.3, 95 %CI = 2.2–5.1, p < 0.01). Ticagrelor reached a lower plasma concentration in morphine group (MD = −481.8 ng/ml, 95% CI = −841.2 to −122.4 ng/ml, p < 0.01) with a higher vomiting rate (odds = 5.3, 95% CI = 2.5–11.1, p < 0.01). However, the composite of in-hospital mortality, stroke, and re-infarction was not significantly different between the groups (p = 0.83). Conclusion Co-administration of morphine with P2Y12 inhibitors possibly decreases their efficacy in platelet inhibition. However, this did not translate into higher adverse outcomes because of low event rates, inadequate for analysis. A large randomized study is needed to evaluate the narcotic-P2Y12 interaction.en_US
dc.identifier.affiliationsDepartment of Cardiovascular Medicine, University of Louisville, 201 Abraham Flexner Way, Louisville, KY 40202, USAen_US
dc.identifier.citationVaidya Gaurang Nandkishor, Khan Abdur, Ghafghazi Shahab. Effect of morphine use on oral P2Y12 platelet inhibitors in acute myocardial infarction: Meta-analysis. Indian Heart Journal. 2019 Mar; 71(2): 126-135en_US
dc.identifier.issn0019-4832
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/191709
dc.languageenen_US
dc.publisherCardiological Society of Indiaen_US
dc.relation.issuenumber2en_US
dc.relation.volume71en_US
dc.source.urihttps://doi.org/10.1016/j.ihj.2019.03.003en_US
dc.subjectMorphineen_US
dc.subjectSTEMIen_US
dc.subjectMyocardial infarctionen_US
dc.subjectTicagreloren_US
dc.subjectPrasugrelen_US
dc.subjectPlateletsen_US
dc.subjectAbsorptionen_US
dc.subjectPlatelet activityen_US
dc.subjectOpioiden_US
dc.subjectChest painen_US
dc.subjectDeathen_US
dc.subjectRevascularizationen_US
dc.subjectStent thrombosisen_US
dc.titleEffect of morphine use on oral P2Y12 platelet inhibitors in acute myocardial infarction: Meta-analysisen_US
dc.typeJournal Articleen_US
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