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The safety of morphine use in acute coronary syndrome: a meta-analysis
BACKGROUND: Morphine is widely used for pain control in patients with acute coronary syndrome (ACS). Several studies have questioned the safety of morphine in this setting with a concern of interaction with and reduced efficacy of antiplatelet agents. OBJECTIVE: This study aims to systematically rev...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454327/ https://www.ncbi.nlm.nih.gov/pubmed/31031833 http://dx.doi.org/10.1136/heartasia-2018-011142 |
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author | Ghadban, Rugheed Enezate, Tariq Payne, Joshua Allaham, Haytham Halawa, Ahmad Fong, Hee Kong Abdullah, Obai Aggarwal, Kul |
author_facet | Ghadban, Rugheed Enezate, Tariq Payne, Joshua Allaham, Haytham Halawa, Ahmad Fong, Hee Kong Abdullah, Obai Aggarwal, Kul |
author_sort | Ghadban, Rugheed |
collection | PubMed |
description | BACKGROUND: Morphine is widely used for pain control in patients with acute coronary syndrome (ACS). Several studies have questioned the safety of morphine in this setting with a concern of interaction with and reduced efficacy of antiplatelet agents. OBJECTIVE: This study aims to systematically review the safety of morphine use in ACS. METHODS: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were queried from inception through April 2018. Studies comparing morphine to nonmorphine use in ACS were included. Study endpoints included: in-hospital myocardial infarction (MI), all-cause mortality, stroke, major bleeding, minor bleeding and dyspnoea. RESULTS: A total of 64 323 patients with ACS were included from eight studies, seven of which were observational studies and one was a randomised controlled trial. The use of morphine was associated with increased risk of in-hospital recurrent MI (OR 1.30, 95% CI 1.18 to 1.43, p < 0.00001). There was, however, no significant difference in terms of all-cause mortality (OR 0.87, 95% CI 0.62 to 1.22, p = 0.44), stroke (OR 0.81, 95% CI 0.39 to 1.66, p = 0.57), major bleeding (OR 0.49, 95% CI 0.24 to 1.00, p = 0.05), minor bleeding (OR 0.98, 95% CI 0.41 to 2.34, p = 0.97), or dyspnoea (OR 0.55, 95% CI 0.16 to 1.83, p = 0.33). CONCLUSION: The use of morphine for pain control in ACS was associated with an increased risk of in-hospital recurrent MI. Randomised clinical trials are needed to further investigate the safety of morphine in ACS. |
format | Online Article Text |
id | pubmed-6454327 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-64543272019-04-26 The safety of morphine use in acute coronary syndrome: a meta-analysis Ghadban, Rugheed Enezate, Tariq Payne, Joshua Allaham, Haytham Halawa, Ahmad Fong, Hee Kong Abdullah, Obai Aggarwal, Kul Heart Asia Original Research BACKGROUND: Morphine is widely used for pain control in patients with acute coronary syndrome (ACS). Several studies have questioned the safety of morphine in this setting with a concern of interaction with and reduced efficacy of antiplatelet agents. OBJECTIVE: This study aims to systematically review the safety of morphine use in ACS. METHODS: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were queried from inception through April 2018. Studies comparing morphine to nonmorphine use in ACS were included. Study endpoints included: in-hospital myocardial infarction (MI), all-cause mortality, stroke, major bleeding, minor bleeding and dyspnoea. RESULTS: A total of 64 323 patients with ACS were included from eight studies, seven of which were observational studies and one was a randomised controlled trial. The use of morphine was associated with increased risk of in-hospital recurrent MI (OR 1.30, 95% CI 1.18 to 1.43, p < 0.00001). There was, however, no significant difference in terms of all-cause mortality (OR 0.87, 95% CI 0.62 to 1.22, p = 0.44), stroke (OR 0.81, 95% CI 0.39 to 1.66, p = 0.57), major bleeding (OR 0.49, 95% CI 0.24 to 1.00, p = 0.05), minor bleeding (OR 0.98, 95% CI 0.41 to 2.34, p = 0.97), or dyspnoea (OR 0.55, 95% CI 0.16 to 1.83, p = 0.33). CONCLUSION: The use of morphine for pain control in ACS was associated with an increased risk of in-hospital recurrent MI. Randomised clinical trials are needed to further investigate the safety of morphine in ACS. BMJ Publishing Group 2019-03-19 /pmc/articles/PMC6454327/ /pubmed/31031833 http://dx.doi.org/10.1136/heartasia-2018-011142 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Original Research Ghadban, Rugheed Enezate, Tariq Payne, Joshua Allaham, Haytham Halawa, Ahmad Fong, Hee Kong Abdullah, Obai Aggarwal, Kul The safety of morphine use in acute coronary syndrome: a meta-analysis |
title | The safety of morphine use in acute coronary syndrome: a meta-analysis |
title_full | The safety of morphine use in acute coronary syndrome: a meta-analysis |
title_fullStr | The safety of morphine use in acute coronary syndrome: a meta-analysis |
title_full_unstemmed | The safety of morphine use in acute coronary syndrome: a meta-analysis |
title_short | The safety of morphine use in acute coronary syndrome: a meta-analysis |
title_sort | safety of morphine use in acute coronary syndrome: a meta-analysis |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454327/ https://www.ncbi.nlm.nih.gov/pubmed/31031833 http://dx.doi.org/10.1136/heartasia-2018-011142 |
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