The safety of morphine use in acute coronary syndrome: a meta-analysis
Rugheed Ghadban1, Tariq Enezate1, Joshua Payne1
1Division of Cardiology, Department of Internal Medicine, University of Missouri, Columbia, Missouri, USA.
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.
Insights
Morphine use in acute coronary syndrome (ACS) patients increases the risk of in-hospital recurrent myocardial infarction (MI). However, morphine did not significantly affect mortality, stroke, or bleeding events in this systematic review.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Morphine is a common analgesic for acute coronary syndrome (ACS).
- Concerns exist regarding morphine's safety and potential interactions with antiplatelet agents in ACS patients.
- Previous studies suggest potential adverse effects, necessitating a comprehensive safety review.
Purpose of the Study:
- To systematically review the safety of morphine administration in patients diagnosed with ACS.
- To evaluate the association between morphine use and key clinical outcomes in ACS.
Main Methods:
- A systematic literature search was conducted across MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials up to April 2018.
- Included studies compared morphine use versus non-morphine use in ACS patients.
- Primary endpoints assessed were in-hospital myocardial infarction (MI), all-cause mortality, stroke, major and minor bleeding, and dyspnea.
Main Results:
- The review included 64,323 ACS patients from eight studies (seven observational, one RCT).
- Morphine use was significantly associated with an increased risk of in-hospital recurrent MI (OR 1.30).
- No significant differences were observed for all-cause mortality, stroke, major/minor bleeding, or dyspnea.
Conclusions:
- Morphine use in ACS patients is linked to a higher risk of recurrent in-hospital MI.
- Further randomized clinical trials are essential to definitively establish the safety profile of morphine in ACS management.
- Current evidence suggests caution when using morphine for pain relief in ACS.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:20Opioid Analgesics: Morphine and Other Natural Cogeners