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dc.contributor.authorFarag, Mohamed
dc.contributor.authorSpinthakis, Nikolaos
dc.contributor.authorSrinivasan, Manivannan
dc.contributor.authorSullivan, Keith
dc.contributor.authorWellsted, David
dc.contributor.authorGorog, Diana A
dc.date.accessioned2019-02-20T15:55:22Z
dc.date.available2019-02-20T15:55:22Z
dc.date.issued2018-03-01
dc.identifier.citationFarag , M , Spinthakis , N , Srinivasan , M , Sullivan , K , Wellsted , D & Gorog , D A 2018 , ' Morphine Analgesia Pre-PPCI Is Associated with Prothrombotic State, Reduced Spontaneous Reperfusion and Greater Infarct Size ' , Thrombosis and haemostasis , vol. 118 , no. 3 , pp. 601-612 . https://doi.org/10.1055/s-0038-1629896
dc.identifier.issn0340-6245
dc.identifier.otherPURE: 15205319
dc.identifier.otherPURE UUID: 8bdb51a2-f545-4666-87df-b269bd1dbb6f
dc.identifier.otherPubMed: 29444530
dc.identifier.otherScopus: 85042189694
dc.identifier.urihttp://hdl.handle.net/2299/21124
dc.descriptionSchattauer GmbH Stuttgart.
dc.description.abstractThe emergency management of ST-elevation myocardial infarction (STEMI) involves treatment with dual-antiplatelet therapy (DAPT) and primary percutaneous coronary intervention (PPCI). Pain is generally treated with opiates, which may delay gastric transit and reduce DAPT absorption. We sought to assess the effect of morphine on reperfusion, infarct size and thrombotic status in 300 patients presenting for PPCI. Morphine was given in a non-randomized fashion as required by emergency teams en route to the heart attack centre. All patients received DAPT and PPCI according to standard care, with optional glycoprotein IIb/IIIa inhibitor (GPI) use. Patients were assessed for ST-segment resolution, coronary flow, thrombotic status and peak troponin. Patients receiving morphine (n = 218; 72.7%) experienced less spontaneous ST-segment resolution pre-PPCI, lower rate of TIMI 2/3 flow in the infarct-related artery pre-PPCI and higher peak troponin level post-PPCI (median [interquartile range]; 1,906 [1,002-4,398] vs. 1,268 [249-2,920] ng/L; p = 0.016) than those who did not. Patients receiving morphine exhibited significantly enhanced platelet reactivity and impaired endogenous fibrinolysis on arrival, compared with no-morphine patients. Morphine administration was an independent predictor of failure of spontaneous ST-segment resolution after adjustment for other variables (odds ratio: 0.26; confidence interval: 0.08-0.84; p = 0.025). Among patients receiving GPI, there was no difference in pre-PPCI flow or peak troponin according to morphine use, suggesting that the adverse effects of morphine relate to delayed DAPT absorption, which may be overcome by GPI. Our hypothesis-generating data suggest that morphine use in STEMI is associated with enhanced platelet reactivity, reduced spontaneous myocardial reperfusion (pre-PPCI) and larger infarct size, and these adverse effects may be influenced by GPI use. CLINICAL TRIAL REGISTRATION:  URL: http://www.clinicaltrials.gov. Unique identifier: NCT02562690.en
dc.format.extent12
dc.language.isoeng
dc.relation.ispartofThrombosis and haemostasis
dc.rightsEmbargoed
dc.subjectendogenous fibrinolysis
dc.subjectmorphine
dc.subjectopiates
dc.subjectpercutaneous coronary intervention
dc.subjectthrombosis
dc.subjectHematology
dc.titleMorphine Analgesia Pre-PPCI Is Associated with Prothrombotic State, Reduced Spontaneous Reperfusion and Greater Infarct Sizeen
dc.contributor.institutionCentre for Health Services and Clinical Research
dc.contributor.institutionDepartment of Clinical and Pharmaceutical Sciences
dc.description.statusPeer reviewed
dc.date.embargoedUntil2019-02-14
dc.identifier.urlhttp://www.scopus.com/inward/record.url?scp=85042189694&partnerID=8YFLogxK
dc.description.versiontypeFinal Accepted Version
dcterms.dateAccepted2018-03-01
rioxxterms.versionAM
rioxxterms.versionAM
rioxxterms.versionofrecordhttps://doi.org/10.1055/s-0038-1629896
rioxxterms.licenseref.uriOther
rioxxterms.licenseref.startdate2019-02-14
rioxxterms.typeJournal Article/Review
herts.preservation.rarelyaccessedtrue
herts.date.embargo2019-02-14
herts.rights.accesstypeEmbargoed


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