Moore Catherine H, Lukas Jack G, Cave Brandon E, Khouzam Rami N
Department of Pharmacy, Methodist University Hospital, Memphis, TN; Department of Clinical and Translational Science, University of Tennessee Health Sciences Center, Memphis, TN.
Department of Pharmacy, Methodist University Hospital, Memphis, TN.
Curr Probl Cardiol. 2021 Apr;46(4):100781. doi: 10.1016/j.cpcardiol.2020.100781. Epub 2020 Dec 26.
Morphine has been long recognized as standard of care in the treatment of acute coronary syndrome (ACS) patients; however, its safety has recently been called into question due to a drug interaction with P2Y inhibitors. Opioids, given in combination with P2Y inhibitors, can reduce antiplatelet effects by slowing gastrointestinal motility and ultimately reducing drug absorption. While there are proposed benefits of opioids in ACS patients, conflicting data regarding clinical outcomes exist. The majority of clinical data slightly favors opioid use in ST-elevation myocardial infarction over non-ST-elevation myocardial infarction, although trends for increased myocardial infarction are present in both settings. Current practice should be aimed at discerning the need for routine opioid use in ACS. Alternative strategies may be needed to overcome these interactions; however, no robust data are currently available to support these treatment options. Future research should be aimed at non-opioid treatment options in ACS, as opioid use remains controversial in this population.
长期以来，吗啡一直被视为治疗急性冠状动脉综合征（ACS）患者的护理标准；然而，由于与P2Y抑制剂存在药物相互作用，其安全性最近受到质疑。阿片类药物与P2Y抑制剂联合使用时，可通过减缓胃肠蠕动并最终减少药物吸收来降低抗血小板作用。虽然阿片类药物对ACS患者有潜在益处，但关于临床结局的数据存在冲突。大多数临床数据略微倾向于在ST段抬高型心肌梗死患者中使用阿片类药物而非非ST段抬高型心肌梗死患者，尽管在这两种情况下都存在心肌梗死增加的趋势。当前的做法应旨在确定ACS患者常规使用阿片类药物的必要性。可能需要替代策略来克服这些相互作用；然而，目前尚无有力数据支持这些治疗选择。未来的研究应针对ACS的非阿片类治疗选择，因为在这一人群中使用阿片类药物仍存在争议。
