Vol 5, No 1 (2020)
Review article
Published online: 2020-03-31
Does morphine remain a standard of care in acute myocardial infarction?
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Medical Research Journal 2020;5(1):46-49.
Abstract
Morphine is routinely used for pain relief in patients with acute myocardial infarction. However, it was documented that morphine decreases the bioavailability and antiplatelet effect of P2Y12 receptor inhibitors. Multiple strategies to overcome this undesirable interaction are currently under investigation; they include the follwing: administration of crushed ticagrelor tablets, co-administration of metoclopramide, bridging with intravenous antiplatelet agents, or replacement of morphine with other analgesic. Adequately powered randomised trials examining the clinical consequences of concomitant use of morphine and P2Y12 receptor inhibitors are still lacking.
Keywords: morphineP2Y12 receptor inhibitorsclopidogrelticagrelorprasugrelmyocardial infarction
References
- Kubica J, Adamski P, Paciorek P, et al. Treatment of patients with acute coronary syndrome: Recommendations for medical emergency teams: Focus on antiplatelet therapies. Updated experts' standpoint. Cardiol J. 2018; 25(3): 291–300.
- Ibanez B, James S, Agewall S, et al. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2): 119–177.
- Steg PhG, James SK, Atar D, et al. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012; 33(20): 2569–2619.
- Kubica J, Adamski P, Ostrowska M, et al. Influence of Morphine on Pharmacokinetics and Pharmacodynamics of Ticagrelor in Patients with Acute Myocardial Infarction (IMPRESSION): study protocol for a randomized controlled trial. Trials. 2015; 16(3): 198–252.
- Roffi M, Patrono C, Collet JP, et al. ESC Scientific Document Group. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37(3): 267–315.
- Neumann FJ, Sousa-Uva M, Ahlsson A, et al. ESC Scientific Document Group, ESC Scientific Document Group. Considerations for the choice between coronary artery bypass grafting and percutaneous coronary intervention as revascularization strategies in major categories of patients with stable multivessel coronary artery disease: an accompanying article of the task force of the 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J. 2019; 40(2): 204–212.
- Bartko J, Schoergenhofer C, Schwameis M, et al. Morphine Interaction with Aspirin: a Double-Blind, Crossover Trial in Healthy Volunteers. J Pharmacol Exp Ther. 2018; 365(2): 430–436.
- Meine TJ, Roe MT, Chen AY, et al. CRUSADE Investigators. Association of intravenous morphine use and outcomes in acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. Am Heart J. 2005; 149(6): 1043–1049.
- Hobl EL, Reiter B, Schoergenhofer C, et al. Morphine decreases ticagrelor concentrations but not its antiplatelet effects: a randomized trial in healthy volunteers. Eur J Clin Invest. 2016; 46(1): 7–14.
- Adamski P, Sikora J, Laskowska E, et al. Comparison of bioavailability and antiplatelet action of ticagrelor in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction: A prospective, observational, single-centre study. PLoS One. 2017; 12(10): e0186013.
- Adamski P, Buszko K, Sikora J, et al. Determinants of high platelet reactivity in patients with acute coronary syndromes treated with ticagrelor. Sci Rep. 2019; 9(1): 3924.
- Thomas MR, Morton AC, Hossain R, et al. Morphine delays the onset of action of prasugrel in patients with prior history of ST-elevation myocardial infarction. Thromb Haemost. 2016; 116(1): 96–102.
- Siller-Matula JM, Specht S, Kubica J, et al. Abciximab as a bridging strategy to overcome morphine-prasugrel interaction in STEMI patients. Br J Clin Pharmacol. 2016; 82(5): 1343–1350.
- Parodi G. Editor's Choice-Chest pain relief in patients with acute myocardial infarction. Eur Heart J Acute Cardiovasc Care. 2016; 5(3): 277–281.
- Holzer P. Opioid receptors in the gastrointestinal tract. Regul Pept. 2009; 155(1-3): 11–17.
- Umińska JM, Ratajczak J, Buszko K, et al. Impact of mild therapeutic hypothermia on bioavailability of ticagrelor in patients with acute myocardial infarction after out-of-hospital cardiac arrest. Cardiol J. 2019 [Epub ahead of print].
- Schoergenhofer C, Hobl EL, Staudinger T, et al. Prasugrel in critically ill patients. Thromb Haemost. 2017; 117(8): 1582–1587.
- Alexopoulos D, Barampoutis N, Gkizas V, et al. Crushed Versus Integral Tablets of Ticagrelor in ST-Segment Elevation Myocardial Infarction Patients: A Randomized Pharmacokinetic/Pharmacodynamic Study. Clin Pharmacokinet. 2016; 55(3): 359–367.
- Niezgoda P, Sikora J, Barańska M, et al. Crushed sublingual versus oral ticagrelor administration strategies in patients with unstable angina. A pharmacokinetic/pharmacodynamic study. Thromb Haemost. 2017; 117(4): 718–726.
- Sikora J, Niezgoda P, Barańska M, et al. METoclopramide Administration as a Strategy to Overcome MORPHine-ticagrelOr Interaction in PatientS with Unstable Angina PectorIS-The METAMORPHOSIS Trial. Thromb Haemost. 2018; 118(12): 2126–2133.
- Franchi F, Rollini F, Park Y, et al. Effects of Methylnaltrexone on Ticagrelor-Induced Antiplatelet Effects in Coronary Artery Disease Patients Treated With Morphine. JACC Cardiovasc Interv. 2019; 12(16): 1538–1549.
- Kubica J, Kozinski M, Navarese EP, et al. Cangrelor: an emerging therapeutic option for patients with coronary artery disease. Curr Med Res Opin. 2014; 30(5): 813–828.
- Kubica J, Kubica A, Jilma B, et al. Impact of morphine on antiplatelet effects of oral P2Y12 receptor inhibitors. Int J Cardiol. 2016; 215: 201–208.
- Aradi D, Komócsi A, Vorobcsuk A, et al. Prognostic significance of high on-clopidogrel platelet reactivity after percutaneous coronary intervention: systematic review and meta-analysis. Am Heart J. 2010; 160(3): 543–551.
- Stone GW, Witzenbichler B, Weisz G, et al. ADAPT-DES Investigators. Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES): a prospective multicentre registry study. Lancet. 2013; 382(9892): 614–623.
- Ostrowska M, Kubica J, Adamski P, et al. Stratified Approaches to Antiplatelet Therapies Based on Platelet Reactivity Testing. Front Cardiovasc Med. 2019; 6: 176.
- Hobl EL, Stimpfl T, Ebner J, et al. Morphine decreases clopidogrel concentrations and effects: a randomized, double-blind, placebo-controlled trial. J Am Coll Cardiol. 2014; 63(7): 630–635.
- Hobl EL, Reiter B, Schoergenhofer C, et al. Morphine interaction with prasugrel: a double-blind, cross-over trial in healthy volunteers. Clin Res Cardiol. 2016; 105(4): 349–355.
- Parodi G, Bellandi B, Xanthopoulou I, et al. Morphine is associated with a delayed activity of oral antiplatelet agents in patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention. Circ Cardiovasc Interv. 2015; 8(1).
- Farag M, Spinthakis N, Srinivasan M, et al. Morphine Analgesia Pre-PPCI Is Associated with Prothrombotic State, Reduced Spontaneous Reperfusion and Greater Infarct Size. Thromb Haemost. 2018; 118(3): 601–612.
- Batchelor R, Liu DH, Bloom J, et al. Association of periprocedural intravenous morphine use on clinical outcomes in ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention: Systematic review and meta-analysis. Catheter Cardiovasc Interv. 2019 [Epub ahead of print].