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Original research
The safety of morphine use in acute coronary syndrome: a meta-analysis
  1. Rugheed Ghadban1,
  2. Tariq Enezate1,
  3. Joshua Payne1,
  4. Haytham Allaham2,
  5. Ahmad Halawa1,
  6. Hee Kong Fong2,
  7. Obai Abdullah1,
  8. Kul Aggarwal1
  1. 1 Division of Cardiology, Department of Internal Medicine, University of Missouri, Columbia, Missouri, USA
  2. 2 Department of Internal Medicine, University of Missouri, Columbia, Missouri, USA
  1. Correspondence to Dr Tariq Enezate, Division of Cardiology, Department of Internal Medicine, University of Missouri, Columbia, MI 65211, USA; enezatet{at}health.missouri.edu

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.

  • acute coronary syndrome
  • antiplatelet
  • morphine
  • safety of morphine in acute coronary syndrome

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/.

https://doi.org/10.1136/heartasia-2018-011142

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    Footnotes

    • Contributors RG: conception, study design, data collection and interpretation, drafting and editing the manuscript, and final approval. TE: conception, study design, data collection and interpretation, statistical analysis, drafting and editing the manuscript, and final approval. JP: conception, study design, data collection interpretation, drafting and editing the manuscript, and final approval. HA: data collection and interpretation, drafting and editing the manuscript, and final approval. AH: data collection and interpretation, drafting and editing the manuscript, and final approval. HKF: data collection and interpretation, drafting and editing the manuscript, and final approval. OA: data collection and interpretation, drafting and editing the manuscript, and final approval. KA: revising the manuscript, critical editing and final approval.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.