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Should STEMI Patients Receive Opiate Analgesia? The Morphine Paradox

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Should STEMI Patients Receive Opiate Analgesia? The Morphine Paradox. / Farag, Mohamed; Spinthakis, Nikolaos; Srinivasan, Manivannan; Gorog, Diana Adrienne.

In: Current vascular pharmacology, Vol. 16, No. 5, 17.01.2018, p. 477-483.

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Farag, Mohamed ; Spinthakis, Nikolaos ; Srinivasan, Manivannan ; Gorog, Diana Adrienne. / Should STEMI Patients Receive Opiate Analgesia? The Morphine Paradox. In: Current vascular pharmacology. 2018 ; Vol. 16, No. 5. pp. 477-483.

Bibtex

@article{8280390ca0d947078be4c84b46e7c43d,
title = "Should STEMI Patients Receive Opiate Analgesia?: The Morphine Paradox",
abstract = "BACKGROUND: The very significant benefit of P2Y12 receptor inhibitor administration in patients with ST-elevation myocardial infarction (STEMI), in reducing future ischaemic events and stent thrombosis, is undisputed. Morphine analgesia is very frequently co-administered to these patients for pain relief, along with antiplatelet therapy, at the time of presentation, and prior to reperfusion with primary percutaneous coronary intervention.METHODS: Research and online content related to opiates use in STEMI was reviewed. Bibliographies of retrieved studies were searched manually for additional studies and reviews.RESULTS: There is sufficient data from pharmacokinetic and pharmacodynamic studies showing that the co-administration of morphine with oral P2Y12 receptor inhibitor results in delayed antiplatelet effects. However, whether this results in adverse outcomes remains unclear. Data from studies reporting the effect of morphine on clinical outcomes in STEMI are inconsistent, although they tend to be underpowered to show an effect on hard clinical outcomes, but some clearly show a relationship between morphine use and infarct size. Strategies to overcome the potentially significant negative impact of morphine on platelet reactivity in STEMI are discussed.CONCLUSION: Whilst clearly definitive, adequately powered, randomised controlled trials are lacking, we would recommend avoiding the combination of morphine with oral P2Y12 receptor inhibitors and recommend alternative strategies including intravenous platelet inhibitor strategies, in high risk patients.",
keywords = "Acute coronary syndrome, Antiplatelet therapy, Morphine, Myocardial infarction, Opiates, Platelet reactivity",
author = "Mohamed Farag and Nikolaos Spinthakis and Manivannan Srinivasan and Gorog, {Diana Adrienne}",
note = "Copyright{\textcopyright} Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.",
year = "2018",
month = jan,
day = "17",
doi = "10.2174/1570161116666180117145704",
language = "English",
volume = "16",
pages = "477--483",
journal = "Current vascular pharmacology",
issn = "1570-1611",
publisher = "Bentham Science Publishers B.V.",
number = "5",

}

RIS

TY - JOUR

T1 - Should STEMI Patients Receive Opiate Analgesia?

T2 - The Morphine Paradox

AU - Farag, Mohamed

AU - Spinthakis, Nikolaos

AU - Srinivasan, Manivannan

AU - Gorog, Diana Adrienne

N1 - Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

PY - 2018/1/17

Y1 - 2018/1/17

N2 - BACKGROUND: The very significant benefit of P2Y12 receptor inhibitor administration in patients with ST-elevation myocardial infarction (STEMI), in reducing future ischaemic events and stent thrombosis, is undisputed. Morphine analgesia is very frequently co-administered to these patients for pain relief, along with antiplatelet therapy, at the time of presentation, and prior to reperfusion with primary percutaneous coronary intervention.METHODS: Research and online content related to opiates use in STEMI was reviewed. Bibliographies of retrieved studies were searched manually for additional studies and reviews.RESULTS: There is sufficient data from pharmacokinetic and pharmacodynamic studies showing that the co-administration of morphine with oral P2Y12 receptor inhibitor results in delayed antiplatelet effects. However, whether this results in adverse outcomes remains unclear. Data from studies reporting the effect of morphine on clinical outcomes in STEMI are inconsistent, although they tend to be underpowered to show an effect on hard clinical outcomes, but some clearly show a relationship between morphine use and infarct size. Strategies to overcome the potentially significant negative impact of morphine on platelet reactivity in STEMI are discussed.CONCLUSION: Whilst clearly definitive, adequately powered, randomised controlled trials are lacking, we would recommend avoiding the combination of morphine with oral P2Y12 receptor inhibitors and recommend alternative strategies including intravenous platelet inhibitor strategies, in high risk patients.

AB - BACKGROUND: The very significant benefit of P2Y12 receptor inhibitor administration in patients with ST-elevation myocardial infarction (STEMI), in reducing future ischaemic events and stent thrombosis, is undisputed. Morphine analgesia is very frequently co-administered to these patients for pain relief, along with antiplatelet therapy, at the time of presentation, and prior to reperfusion with primary percutaneous coronary intervention.METHODS: Research and online content related to opiates use in STEMI was reviewed. Bibliographies of retrieved studies were searched manually for additional studies and reviews.RESULTS: There is sufficient data from pharmacokinetic and pharmacodynamic studies showing that the co-administration of morphine with oral P2Y12 receptor inhibitor results in delayed antiplatelet effects. However, whether this results in adverse outcomes remains unclear. Data from studies reporting the effect of morphine on clinical outcomes in STEMI are inconsistent, although they tend to be underpowered to show an effect on hard clinical outcomes, but some clearly show a relationship between morphine use and infarct size. Strategies to overcome the potentially significant negative impact of morphine on platelet reactivity in STEMI are discussed.CONCLUSION: Whilst clearly definitive, adequately powered, randomised controlled trials are lacking, we would recommend avoiding the combination of morphine with oral P2Y12 receptor inhibitors and recommend alternative strategies including intravenous platelet inhibitor strategies, in high risk patients.

KW - Acute coronary syndrome

KW - Antiplatelet therapy

KW - Morphine

KW - Myocardial infarction

KW - Opiates

KW - Platelet reactivity

UR - http://www.scopus.com/inward/record.url?scp=85057448451&partnerID=8YFLogxK

U2 - 10.2174/1570161116666180117145704

DO - 10.2174/1570161116666180117145704

M3 - Review article

C2 - 29345594

VL - 16

SP - 477

EP - 483

JO - Current vascular pharmacology

JF - Current vascular pharmacology

SN - 1570-1611

IS - 5

ER -