The safety of morphine use in acute coronary syndrome: a meta-analysis. Issue 1 (19th March 2019)

• Record Type: Journal Article
• Authors: Ghadban, Rugheed; Enezate, Tariq; Payne, Joshua; Allaham, Haytham; Halawa, Ahmad; Fong, Hee Kong; Abdullah, Obai; Aggarwal, Kul
• Is Part Of: Heart Asia. Volume 11:Issue 1(2019)
• Publication Date: 2019-03-19
• Subjects: acute coronary syndrome -- antiplatelet -- morphine -- safety of morphine in acute coronary syndrome
• DOI: 10.1136/heartasia-2018-011142
• Languages: English
• ISSNs: 2398-5968

Abstract

Abstract : 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.