Morphine, blood thinner plavix a bad mix for heart attack victims

December 4, 2013 by Dennis Thompson, Healthday Reporter
Morphine, blood thinner plavix a bad mix for heart attack victims: study
Painkiller appeared to slow, diminish anti-clotting effect of heart drug.

(HealthDay)—Morphine appears to reduce the effectiveness of the commonly used blood-thinning drug Plavix, which could hamper emergency-room efforts to treat heart attack victims, Austrian researchers report.

The finding could create serious dilemmas in the ER, where doctors have to weigh a heart patient's intense pain against the need to break up and prevent , said Dr. Deepak Bhatt, executive director of interventional cardiovascular programs at Brigham and Women's Hospital Heart and Vascular Center, in Boston.

"If a patient is having crushing heart pain, you can't just tell them to tough it out, and is the most commonly used medication in that situation," said Bhatt, who was not involved in the study. "Giving them morphine is the humane thing to do, but it could also create delays in care."

Doctors will have to be particularly careful if a heart attack patient needs to have a stent implanted, he said. Blood thinners are critical in preventing clots from forming around the stent.

"If that situation is unfolding, it requires a little bit of extra thought on the part of the physician whether they want to give that full slug of morphine or not," Bhatt said.

About half of the 600,000 stent procedures that take place in the United States each year occur as the result of a heart attack, angina or other , he said.

The Austrian researchers focused on 24 healthy people who received either a dose of Plavix with an injection of morphine or a placebo drug.

Morphine delayed the ability of Plavix (clopidogrel) to thin a patient's blood by an average of two hours, the researchers said.

The painkiller also delayed the body's absorption of Plavix and decreased blood levels of the drug by about half. It further seemed to diminish the effectiveness of the medication in breaking up blood clots.

Although the study showed an association between morphine and diminished effectiveness of Plavix, however, it did not prove a cause-and-effect relationship.

"Co-administration of morphine and [Plavix] should likely be avoided, if possible," the researchers said.

Their findings were published online Dec. 4 in the Journal of the American College of Cardiology.

This potential drug interaction is not well known, and Bhatt said news of these findings needs to be distributed as soon as possible.

"The first step would be awareness," he said. "I don't think many doctors are going to ever think of this potential interaction."

Bhatt said he isn't concerned about heart attack victims who are taking Plavix prior to their cardiac episode, because the drug already will be built up in their bloodstream.

The people with the most potential for harm are those not taking Plavix who are in the middle of a and need both pain relief and an immediate high level of the blood thinner in their system, he said.

One option to get around this interaction is to get the patient into a catheterization lab as soon as possible to treat the source of the pain rather than using morphine to dull the pain, Bhatt said.

Doctors might also use other blood-thinning drugs, said Dr. Gregg Fonarow, a spokesman for the American Heart Association.

Although Plavix is a widely used therapy, many medications have been shown to interfere with its ability to act, he said.

"More potent antiplatelet agents—prasugrel [Effient] and ticagrelor [Brilinta]—are now available for treatment of patients with acute coronary syndromes and do not have the same type of drug interactions," said Fonarow, who is also a professor of cardiology at the University of California, Los Angeles.

Bhatt, however, said he is concerned that morphine might have the same effect on these other .

"I think there's a reasonable chance the same phenomenon might occur with both those agents," he said. "We need further research."

Explore further: Plavix's new generic status could be boon for patients

More information: For more on heart attacks, visit the U.S. National Heart, Lung, and Blood Institute.

Related Stories

Plavix's new generic status could be boon for patients

May 15, 2012
(HealthDay) -- The blockbuster drug Plavix (clopidogrel), used to prevent clotting in some heart patients, will go off patent in the United States on Thursday, making it considerably more affordable.

Allergy to Plavix can be overcome: study

January 16, 2012
Allergies to Plavix, also know by its chemical name, Clopidogrel occur in about six percent of patients given the drug, vital for the prevention of life-threatening stent thrombosis after angioplasty and percutaneous coronary ...

More potent anti-clotting drugs with angiography may benefit patients with acute chest pain

August 15, 2013
Current methods to treat acute coronary syndrome conditions, such as heart attack, include artery-clearing procedures (e.g., percutaneous coronary intervention or coronary artery bypass grafting) with medications, or medications ...

Using morphine after abdominal surgery may prolong pain, researchers find

November 12, 2013
Using morphine to fight the pain associated with abdominal surgery may paradoxically prolong a patient's suffering, doubling or even tripling the amount of time it takes to recover from the surgical pain, according to researchers ...

Researcher finds method to improve morphine's effect on managing pain

October 4, 2013
A method to prevent the body from developing tolerance to morphine, a powerful and commonly used pain medication, has been discovered by a Georgia State University researcher.

Novel anti-clotting drug more effective than Plavix in coronary procedures, study says

March 11, 2013
(Medical Xpress)—An experimental drug has been shown to be significantly more effective at preventing blood clots during coronary stenting procedures compared to the anti-clotting agent now typically used, according to ...

Recommended for you

Researchers borrow from AIDS playbook to tackle rheumatic heart disease

January 22, 2018
Billions of US taxpayer dollars have been invested in Africa over the past 15 years to improve care for millions suffering from the HIV/AIDS epidemic; yet health systems on the continent continue to struggle. What if the ...

A nanoparticle inhalant for treating heart disease

January 18, 2018
A team of researchers from Italy and Germany has developed a nanoparticle inhalant for treating people suffering from heart disease. In their paper published in the journal Science Translational Medicine, the group describes ...

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.