Morphine in acute coronary syndrome : systematic review and meta-analysis

Detalhes bibliográficos
Autor(a) principal: Duarte, Gonçalo Silva
Data de Publicação: 2019
Outros Autores: Nunes-Ferreira, Afonso, Rodrigues, Filipe Brogueira, Pinto, Fausto J., Ferreira, Joaquim J., Costa, João, Caldeira, Daniel
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10451/37602
Resumo: © 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.
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spelling Morphine in acute coronary syndrome : systematic review and meta-analysis© 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.Objective: Morphine is frequently used in acute coronary syndrome (ACS) due to its analgesic effect, it being recommended in the main cardiology guidelines in Europe and the USA. However, controversy exists regarding its routine use due to potential safety concerns. We conducted a systematic review of randomised-controlled trials (RCTs) and observational studies to synthesise the available evidence. Design: Systematic review and meta-analysis. Data sources: CENTRAL, MEDLINE, EMBASE and trial registries. Eligibility criteria for selecting studies: We included RCTs and observational studies evaluating the impact of morphine in cardiovascular outcomes or platelet reactivity measures. Data extraction and synthesis: Data were screened, extracted and appraised by two independent reviewers. The data were pooled results using a random-effects model. Outcomes included in-hospital mortality, major adverse cardiovascular events (MACE), platelet reactivity (using VerifyNow) and bleeding, reported as relative risk (RR) with 95%CI. We assessed the confidence in the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. We followed the Metaanalysis Of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines. Results: Five RCTs and 12 observational studies were included, enrolling 69 993 participants. Pooled results showed an increased risk of in-hospital mortality (RR 1.45 [95% CI 1.10 to 1.91], low GRADE confidence), MACE (RR 1.21, 95%CI 1.02 to 1.45) and an increased platelet reactivity at 1 and 2 hours (59.37 platelet reactivity units [PRU], 95%CI 36.04 to 82.71; 68.28 PRU, 95%CI 37.01 to 99.55, high GRADE confidence) associated with morphine. We found no significant difference in the risk of bleeding. We found no differences in subgroup analyses based on study design and ACS subtype. Conclusions: Morphine was associated with an increased risk of in-hospital mortality and MACE but the high risk of bias leads to low result confidence. There is high confidence that morphine decreases the antiplatelet effect of P2Y12 inhibitors.UID/BIM/50005/2019, project funded by Fundação para a Ciência e a Tecnologia (FCT)/ Ministério da Ciência, Tecnologia e Ensino Superior (MCTES) through Fundos do Orçamento de Estado.BMJ Publishing GroupRepositório da Universidade de LisboaDuarte, Gonçalo SilvaNunes-Ferreira, AfonsoRodrigues, Filipe BrogueiraPinto, Fausto J.Ferreira, Joaquim J.Costa, JoãoCaldeira, Daniel2019-03-19T16:55:27Z20192019-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10451/37602engBMJ Open 2019;9:e0252322044-605510.1136/bmjopen-2018-025232info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-11-08T16:34:49Zoai:repositorio.ul.pt:10451/37602Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T21:51:37.116873Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Morphine in acute coronary syndrome : systematic review and meta-analysis
title Morphine in acute coronary syndrome : systematic review and meta-analysis
spellingShingle Morphine in acute coronary syndrome : systematic review and meta-analysis
Duarte, Gonçalo Silva
title_short Morphine in acute coronary syndrome : systematic review and meta-analysis
title_full Morphine in acute coronary syndrome : systematic review and meta-analysis
title_fullStr Morphine in acute coronary syndrome : systematic review and meta-analysis
title_full_unstemmed Morphine in acute coronary syndrome : systematic review and meta-analysis
title_sort Morphine in acute coronary syndrome : systematic review and meta-analysis
author Duarte, Gonçalo Silva
author_facet Duarte, Gonçalo Silva
Nunes-Ferreira, Afonso
Rodrigues, Filipe Brogueira
Pinto, Fausto J.
Ferreira, Joaquim J.
Costa, João
Caldeira, Daniel
author_role author
author2 Nunes-Ferreira, Afonso
Rodrigues, Filipe Brogueira
Pinto, Fausto J.
Ferreira, Joaquim J.
Costa, João
Caldeira, Daniel
author2_role author
author
author
author
author
author
dc.contributor.none.fl_str_mv Repositório da Universidade de Lisboa
dc.contributor.author.fl_str_mv Duarte, Gonçalo Silva
Nunes-Ferreira, Afonso
Rodrigues, Filipe Brogueira
Pinto, Fausto J.
Ferreira, Joaquim J.
Costa, João
Caldeira, Daniel
description © 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.
publishDate 2019
dc.date.none.fl_str_mv 2019-03-19T16:55:27Z
2019
2019-01-01T00:00:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10451/37602
url http://hdl.handle.net/10451/37602
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv BMJ Open 2019;9:e025232
2044-6055
10.1136/bmjopen-2018-025232
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BMJ Publishing Group
publisher.none.fl_str_mv BMJ Publishing Group
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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