Morphine in myocardial infarction: balancing on the tight rope

This editorial refers to ‘Morphine delays and attenuates ticagrelor exposure and action in patients with myocardial infarction: the randomized, double-blind, placebo-controlled IMPRESSION trial’[†][1], by J. Kubica et al ., on page 245. In the current issue of the journal, Kubica and co-workers present findings of attenuated platelet inhibition by ticagrelor induced by the concomitant administration of morphine.1 The authors tested a 5 mg intravenous dose of morphine against placebo in 70 patients with acute myocardial infarction (AMI), followed by a 180 mg loading dose of ticagrelor. The measured parameters included ticagrelor plasma concentrations and several platelet function tests. All assessments showed a delayed ticagrelor plasma appearance as well as a weaker antiplatelet effect in the morphine group. From the consistency of the data and the methodologically sound approach, it appears that this discovery is founded on solid grounds, and it may trigger an immediate supposition in the cardiovascular … [1]: #fn-2