Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India; Adjunct Faculty, Department of Engineering and design, Indian Institute of Technology-Madras, Chennai, India.
Department of Pathology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), No.1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu 600116, India.
Int J Cardiol. 2021 May 1;330:1-6. doi: 10.1016/j.ijcard.2021.02.037. Epub 2021 Feb 15.
Dual antiplatelet therapy (DAPT) remains the cornerstone of acute coronary syndrome (ACS) management, and ticagrelor is one of the commonly used second antiplatelet agents. There is some evidence to suggest that morphine may reduce the antiplatelet effect of ticagrelor.
In a single-center, randomized controlled trial, we compared the effect of morphine and fentanyl on platelet aggregation (PA) among patients with ACS treated with ticagrelor. Platelet aggregation was studied by automated light transmittance aggregometry (LTA) at baseline, and at 2 h after ticagrelor loading. The primary outcome was the difference in the maximal inhibition of platelet aggregation [IPA(%)] between the groups at 2 h. Pain relief, and drug-related adverse events were secondary outcomes. Of 136 patients randomized, 70 received fentanyl and 66 received morphine. At baseline, the median (IQR) platelet aggregation [61.35% (54.6 to 70) Vs. 58.8% (52.7 to 72.9)] were comparable between the groups. There was no statistically significant difference between the fentanyl and the morphine groups in IPA at 2-h [85.88%(64.65-98.16) and 81.93%(44.2-98.03), p = 0.09]. However, morphine use was independently associated with a PA of >30% at 2 h (p < 0.009). There was no difference in adverse events.
In patients with ACS, there was no significant difference between the use of fentanyl or morphine on the effect of ticagrelor on PA. (CTRI/2018/04/013423).
双联抗血小板治疗（DAPT）仍然是急性冠脉综合征（ACS）管理的基石，替格瑞洛是常用的第二种抗血小板药物之一。有一些证据表明，吗啡可能会降低替格瑞洛的抗血小板作用。
在一项单中心、随机对照试验中，我们比较了吗啡和芬太尼对接受替格瑞洛治疗的 ACS 患者血小板聚集（PA）的影响。通过自动透光比浊法（LTA）在基线和替格瑞洛负荷后 2 小时测量血小板聚集。主要结局是两组在 2 小时时血小板最大抑制率（IPA（%））的差异。次要结局是疼痛缓解和药物相关不良事件。在随机分组的 136 例患者中，70 例接受芬太尼，66 例接受吗啡。基线时，两组的中位（IQR）血小板聚集[61.35%（54.6 至 70）比 58.8%（52.7 至 72.9）]相当。芬太尼组和吗啡组 2 小时 IPA 无统计学差异[85.88%（64.65-98.16）和 81.93%（44.2-98.03），p=0.09]。然而，吗啡的使用与 2 小时时 PA 大于 30%独立相关（p<0.009）。两组不良事件无差异。
在 ACS 患者中，芬太尼或吗啡的使用对替格瑞洛对 PA 的影响无显著差异。（CTRI/2018/04/013423）。
