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Garin D, Degrauwe S, Carbone F, Musayeb Y, Lauriers N, Valgimigli M, Iglesias JF. Differential impact of fentanyl and morphine doses on ticagrelor-induced platelet inhibition in ST-segment elevation myocardial infarction: a subgroup analysis from the PERSEUS randomized trial. Front Cardiovasc Med 2024; 11:1324641. [PMID: 38628315 PMCID: PMC11018886 DOI: 10.3389/fcvm.2024.1324641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), intravenous fentanyl does not enhance ticagrelor-induced platelet inhibition within 2 h compared to morphine. The impact of the total dose of fentanyl and morphine received on ticagrelor pharmacodynamic and pharmacokinetic responses in patients with STEMI remains however undetermined. Materials and methods We performed a post-hoc subanalysis of the prospective, open-label, single-center, randomized PERSEUS trial (NCT02531165) that compared treatment with intravenous fentanyl vs. morphine among symptomatic patients with STEMI treated with primary PCI after ticagrelor pretreatment. Patients from the same population as PERSEUS were further stratified according to the total dose of intravenous opioids received. The primary outcome was platelet reactivity using P2Y12 reaction units (PRU) at 2 h following administration of a loading dose (LD) of ticagrelor. Secondary outcomes were platelet reactivity and peak plasma levels of ticagrelor and AR-C124910XX, its active metabolite, at up to 12 h after ticagrelor LD administration. Generalized linear models for repeated measures were built to determine the relationship between raw and weight-weighted doses of fentanyl and morphine. Results 38 patients with STEMI were included between December 18, 2015, and June 22, 2017. Baseline clinical and procedural characteristics were similar between low- and high-dose opioid subgroups. At 2 h, there was a significant correlation between PRU and both raw [regression coefficient (B), 0.51; 95% confidence interval (CI), 0.02-0.99; p = 0.043] and weight-weighted (B, 0.54; 95% CI, 0.49-0.59; p < 0.001) doses of fentanyl, but not morphine. Median PRU at 2 h was significantly lower in patients receiving low, as compared to high, doses of fentanyl [147; interquartile range (IQR), 63-202; vs. 255; IQR, 183-274; p = 0.028], whereas no significant difference was found in those receiving morphine (217; IQR, 165-266; vs. 237; IQR, 165-269; p = 0.09). At 2 h, weight-weighted doses of fentanyl and morphine were significantly correlated to plasma levels of ticagrelor and AR-C124910XX. Conclusion In symptomatic patients with STEMI who underwent primary PCI after ticagrelor pretreatment and who received intravenous opioids, we found a dose-dependent relationship between the administration of intravenous fentanyl, but not morphine, and ticagrelor-induced platelet inhibition.
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Affiliation(s)
- Dorian Garin
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Degrauwe
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Federico Carbone
- Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino Genoa, Italian Cardiovascular Network, Genoa, Italy
| | - Yazan Musayeb
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Nathalie Lauriers
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marco Valgimigli
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Juan F. Iglesias
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
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Ullah A, Ashiq A, ud Din A, Ali H, Mushtaq T, Awais H, Mannan T, Aslam M. Comparison of Biochemical Parameters with Inhibition of Oxidative Stress in Myocardial Infarction Patients: In Vitro Study. HEALTH SCOPE 2023; 12. [DOI: 10.5812/jhealthscope-134680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/27/2023] [Accepted: 05/13/2023] [Indexed: 09/01/2023]
Abstract
Background: Myocardial infarction (MI) is the main cause of illness, mortality, and stress worldwide. Oxidative stress is the major cause of myocardium tissue damage associated with cell necrosis. Objectives: The current study was designed to compare biochemical parameters with in vitro antioxidant activity in MI patients. Methods: This observational cohort study was conducted on 53 MI patients, and the samples were collected on the basis of a non-random sampling technique from April 2022 to November 2022. Lipid profile (i.e., total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL), and triglycerides (TG)) and cardiac profile (i.e., troponin T, troponin I, creatine kinase MB (CK-MB), and creatine phosphokinase (CPK)) were measured for the confirmation of variation in biochemical parameters. Afterward, the inhibition of oxidative stress was analyzed through the 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay on the serum samples of the patients. Results: Of 53 MI patients, 33 and 20 cases were male and female, respectively. Moreover, the correlation of the DPPH assay with TC, troponin T, and troponin I was determined by Pearson correlation. The correlation coefficients range from -1 to 1, indicating the strength and direction of the linear relationship between the markers. The concentrations of lipid profile (i.e., TC, TG, LDL, and VLDL) or cardiac profile (i.e., CK-MB, CPK, troponin T, and troponin I) were significantly elevated in all MI patients. However, the HDL level (P = 0.001) was decreased. Conclusions: According to obtained results, reactive oxygen species (ROS) might be the causative agent of MI. Therefore, if an antioxidant medication is used as administrative content, it would be helpful for the treatment of MI and a lead mark for pharmaceutical companies in drug designing for MI patients.
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Naryzhnaya NV, Mukhomedzyanov AV, Sirotina M, Maslov LN, Kurbatov BK, Gorbunov AS, Kilin M, Kan A, Krylatov AV, Podoksenov YK, Logvinov SV. δ-Opioid Receptor as a Molecular Target for Increasing Cardiac Resistance to Reperfusion in Drug Development. Biomedicines 2023; 11:1887. [PMID: 37509526 PMCID: PMC10377504 DOI: 10.3390/biomedicines11071887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
An analysis of published data and the results of our own studies reveal that the activation of a peripheral δ2-opioid receptor (δ2-OR) increases the cardiac tolerance to reperfusion. It has been found that this δ2-OR is localized in cardiomyocytes. Endogenous opioids are not involved in the regulation of cardiac resistance to reperfusion. The infarct-limiting effect of the δ2-OR agonist deltorphin II depends on the activation of several protein kinases, including PKCδ, ERK1/2, PI3K, and PKG. Hypothetical end-effectors of the cardioprotective effect of deltorphin II are the sarcolemmal KATP channels and the MPT pore.
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Affiliation(s)
- Natalia V Naryzhnaya
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk 634021, Russia
| | - Alexander V Mukhomedzyanov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk 634021, Russia
| | - Maria Sirotina
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk 634021, Russia
| | - Leonid N Maslov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk 634021, Russia
| | - Boris K Kurbatov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk 634021, Russia
| | - Alexander S Gorbunov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk 634021, Russia
| | - Mikhail Kilin
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk 634021, Russia
| | - Artur Kan
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk 634021, Russia
| | - Andrey V Krylatov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk 634021, Russia
| | - Yuri K Podoksenov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk 634021, Russia
| | - Sergey V Logvinov
- Department of Histology, Embryology and Cytology, Siberian State Medical University, Tomsk 634050, Russia
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4
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Cantor WJ, Tan M, Berwanger O, Lavi S, White HD, Nicolau JC, Dehghani P, Tajer CD, Lopes RD, Moia DDF, Nicholls SJ, Parkhomenko A, Averkov O, Brass N, Lutchmedial S, Malaga G, Damiani LP, Piegas LS, Granger CB, Goodman SG. Morphine and clinical outcomes in patients with ST segment elevation myocardial infarction treated with fibrinolytic and antiplatelet therapy: Insights from the TREAT trial. Am Heart J 2022; 251:1-12. [PMID: 35533724 DOI: 10.1016/j.ahj.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/22/2022] [Accepted: 05/03/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Morphine is commonly used to relieve pain, anxiety and dyspnea in STEMI but it lowers blood pressure and delays the activity of oral antiplatelet agents. The impact of morphine on clinical outcomes remains unknown. This analysis was performed to determine if morphine use was associated with increased risk of adverse clinical events among STEMI patients treated with fibrinolytic therapy and clopidogrel or ticagrelor. METHODS In the Ticagrelor in Patients with ST Elevation Myocardial Infarction Treated with Pharmacological Thrombolysis (TREAT) study, 3799 STEMI patients treated with fibrinolysis were randomized to receive clopidogrel or ticagrelor. Morphine use was left to the discretion of the treating physicians. In this pre-specified analysis, we evaluated clinical outcomes based on the use and timing of morphine administration. Outcomes were stratified by randomized treatment group. Multivariable analysis was performed using Inverse Probability Treatment Weighting (IPTW) weighting. RESULTS Morphine was used in 53% of patients. After adjustment using IPTW weighting, morphine use was associated with higher hazard of reinfarction at 7 days (HR 4.9, P = .0006) and 30 days (HR 1.7, P = .04), and lower hazard of major bleeding (HR 0.37, P = .006). There was no significant difference in mortality at any time point. CONCLUSIONS Among patients with STEMI treated with fibrinolytic therapy, morphine use was associated with a higher risk of early reinfarction and a lower risk of major bleeding but no difference in mortality. CLINICAL TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02298088.
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Affiliation(s)
- Warren J Cantor
- Department of Medicine, Southlake Regional Health Centre, University of Toronto, 581 Davis Drive, Newmarket, Toronto, Ontario L3Y 2P6, Canada.
| | - Mary Tan
- Department of Medicine, Canadian Heart Research Centre, Toronto, Ontario, Canada
| | - Otavio Berwanger
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Shahar Lavi
- Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Harvey D White
- Department of Medicine, Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - Jose C Nicolau
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Payam Dehghani
- Department of Medicine, Prairie Vascular Research Network and Saskatchewan Health Authority, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Carlos D Tajer
- Department of Medicine, Hospital de Alta Complejidad El Cruce, Buenos Aires, Argentina
| | - Renato D Lopes
- Department of Medicine, Duke Clinical Research Institute, Durham, NC, United States; Department of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Diogo D F Moia
- Clinical Operations, Research Institute, Heart Hospital (HCor), São Paulo, Brazil
| | - Stephen J Nicholls
- Department of Medicine, Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Alexander Parkhomenko
- Department of Medicine, Emergency Cardiology Department, Institute of Cardiology, Kiev, Ukraine
| | - Oleg Averkov
- Department of Medicine, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Neil Brass
- Department of Medicine, CK Hui Heart Centre, Edmonton, Alberta, Canada
| | - Sohrab Lutchmedial
- Department of Medicine, New Brunswick Heart Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Germán Malaga
- Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lucas P Damiani
- Clinical Operations, Research Institute, Heart Hospital (HCor), São Paulo, Brazil
| | | | | | - Shaun G Goodman
- Department of Medicine, Canadian Heart Research Centre (CHRC) and Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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5
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Abu Taha A, AbuRuz ME, Momani A. Morphine Use Did Not Eliminate the Effect of Pain on Complications After Acute Myocardial Infarction. Open Nurs J 2022. [DOI: 10.2174/18744346-v16-e2206202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Patients with Acute Myocardial Infarction (AMI) are usually present complaining of severe chest pain. This pain results from an imbalance between oxygen supply and demand, leading to severe complications. Different guidelines recommend using Morphine as a drug of choice for treating this pain.
Objective:
This study aimed to check the effect of chest pain and Morphine use on complications rate after AMI.
Methods:
This was a prospective observational study with a consecutive sample of 300 patients with AMI. Data were collected by direct patients interview and medical records review in the emergency departments & Intensive Care Units (ICU). Any complication developed within the hospital stay and after AMI was recorded. All correlated variables were analyzed using the binary logistic regression model.
Results:
The sample included 176 (58.7%) men and 124 (41.3%) women with a mean age of 56.92±12.13 years. A total of 83 patients (27.7%) developed one or more in-hospital complications. Acute recurrent ischemia was the most frequent complication; 70 (23.3%). Severe chest pain (≥ 7), duration of chest pain (more than 5 minutes), history of previous MI, and history of hypertension increased the occurrence of complications by 13%, 7%, 63%, and 25%, respectively. However, the use of Morphine did not have any protective effect against the development of these complications.
Conclusion:
The severity and duration of chest pain increased the occurrence of complications. Morphine administration did not have any protective effect against the development of these complications. Thus, it is recommended to update different policies and guidelines to use other types of chest pain relief methods, e.g., treating the underlying cause of chest pain and addressing the imbalance between oxygen supply and demand.
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6
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Kubica J, Adamski P, Ładny JR, Kaźmierczak J, Fabiszak T, Filipiak KJ, Gajda R, Gąsior M, Gąsior Z, Gil R, Gorący J, Grajek S, Gromadziński L, Gruchała M, Grześk G, Hoffman P, Jaguszewski MJ, Janion M, Jankowski P, Kalarus Z, Kasprzak JD, Kleinrok A, Kochman W, Kubica A, Kuliczkowski W, Legutko J, Lesiak M, Nadolny K, Navarese EP, Niezgoda P, Ostrowska M, Paciorek P, Siller-Matula J, Szarpak Ł, Timler D, Witkowski A, Wojakowski W, Wysokiński A, Zielińska M. Pre-hospital treatment of patients with acute coronary syndrome: Recommendations for medical emergency teams. Expert position update 2022. Cardiol J 2022; 29:540-552. [PMID: 35514089 PMCID: PMC9273237 DOI: 10.5603/cj.a2022.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/31/2022] [Accepted: 04/24/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jacek Kubica
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Piotr Adamski
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
| | - Jerzy R Ładny
- Department of Emergency Medicine Medical University of Bialystok, Poland
| | | | - Tomasz Fabiszak
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Krzysztof J Filipiak
- Institute of Clinical Medicine, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | | | - Mariusz Gąsior
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Gąsior
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Robert Gil
- Mossakowski Medical Research Institute, Polish Academy of Science, Warsaw, Poland
| | - Jarosław Gorący
- Independent Laboratory of Invasive Cardiology, Pomeranian Medical University, Szczecin, Poland
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | - Stefan Grajek
- Ist Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | - Leszek Gromadziński
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Marcin Gruchała
- Ist Department of Cardiology, Medical University of Gdańsk, Poland
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Nicolaus Copernicus University, Toruń, Poland
| | - Piotr Hoffman
- Department of Congenital Heart Defects, National Institute of Cardiology, Warszawa, Poland
| | | | - Marianna Janion
- Institute of Medical Sciences, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Piotr Jankowski
- Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Epidemiology and Health Promotion, School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Zbigniew Kalarus
- 2nd Chair and Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jarosław D Kasprzak
- 1st Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Łódź, Poland
| | - Andrzej Kleinrok
- University of Information Technology and Management in Rzeszów, Poland
| | - Wacław Kochman
- The National Institute of Cardiology, Department of Cardiology, Bielanski Hospital, Warsaw, Poland
| | - Aldona Kubica
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital in Krakow, Poland
| | - Maciej Lesiak
- Ist Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland
| | | | - Eliano P Navarese
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Piotr Niezgoda
- Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | | | - Jolanta Siller-Matula
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland
- Department of Cardiology, Medical University of Vienna, Austria
| | - Łukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland
| | - Dariusz Timler
- Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Lodz, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Marzenna Zielińska
- Department of Invasive Cardiology, Medical University of Lodz, Lodz, Poland
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Di Fusco SA, Rossini R, Flori M, Pollarolo L, Ingianni N, Malvezzi Caracciolo D'Aquino M, Galati G, Zilio F, Iorio A, Scotto di Uccio F, Lucà F, Gulizia MM, Ciccirillo F, Gabrielli D, Colivicchi F. Pathophysiology and management of recreational drug-related acute coronary syndrome: ANMCO position statement. J Cardiovasc Med (Hagerstown) 2021; 22:79-89. [PMID: 32858637 DOI: 10.2459/jcm.0000000000001091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recreational drug use may cause coronary artery disease through several mechanisms. An increasing number of young patients with drug-related acute coronary syndrome have been reported over recent years. The present position statement reports the most recent epidemiological data on acute coronary syndrome in the setting of drug abuse, describes the main pathophysiological mechanisms underlying coronary artery disease and acute events in these patients, and provides practical recommendations on management and an overview of prognosis.
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Affiliation(s)
| | - Roberta Rossini
- U.O.C. Cardiologia, Azienda Ospedaliera Santa Croce e Carle, Cuneo
| | - Marco Flori
- U.O.C. Cardiologia, Presidio Ospedaliero Unico Urbino (PU)
| | - Luigi Pollarolo
- U.O.C Cardiologia, Ospedale Santo Spirito, Casale Monferrato (AL)
| | - Nadia Ingianni
- U.O.C. Cardiologia, Presidio Ospedaliero Paolo Borsellino, Marsala (TP)
| | | | - Giuseppe Galati
- Divisione di Cardiologia, IRCCS Ospedale San Raffaele, Milan
| | | | - Annamaria Iorio
- U.S.C. Cardiologia 2, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo
| | | | - Fabiana Lucà
- U.O.C. Cardiologia, A.O. Bianchi Melacrino Morelli, Reggio Calabria
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione 'Garibaldi', Catania
- Presidente Fondazione per il Tuo cuore, Firenze - Heart Care Foundation Onlus, Florence
| | | | - Domenico Gabrielli
- U.O.C Cardiologia, Ospedale Civile Augusto Murri, Area Vasta 4 Fermo, ASUR Marche, Fermo (AN), Italy
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, P.O San Filippo Neri - ASL Roma1, Rome
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8
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Effects of morphine on P2Y 12 platelet inhibitors in patients with acute myocardial infarction: A meta-analysis. Am J Emerg Med 2020; 41:219-228. [PMID: 33317866 DOI: 10.1016/j.ajem.2020.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/31/2020] [Accepted: 11/01/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore the effects of morphine on P2Y12 platelet inhibitors in patients with acute myocardial infarction (AMI). METHODS PubMed, Embase, Cochrane Library, and Web of Science were used to retrieve literature through 11th May 2019. Standardized weighted mean difference (SMD) and relative risk (RR) with 95% confidence intervals (CI), P-value, and I2 value were used to assess the strength of the association in this meta-analysis. Outcomes included platelet reactivity, high residual platelet reactivity (HRPR), ticagrelor maximum concentration (Cmax), ticagrelor area under curve (AUC), death rate, reinfarction rate, stroke, stent thrombosis, thrombolysis in myocardial infarction (TIMI) hemorrhage, dyspnea, emesis, contrast-induced nephropathy, and pulmonary edema. RESULTS A total of 13 articles were included in this study, containing 5688 patients (morphine group: n = 2014, control group: n = 3674). Results illustrated that the morphine group had a higher platelet reactivity (SMD: 0.834, 95%CI: 0.483-1.186, P < 0.001) and HRPR rate (RR: 1.994, 95%CI: 1.536-2.588, P < 0.001) than the control group, while the Cmax of ticagrelor (WMD: -481.838, 95%CI: -841.242-122.434, P = 0.009) was lower than that of the control group. The death rate of the morphine group was lower than that in the control group (RR: 0.561, 95%CI: 0.337-0.933, P = 0.026). The morphine group had a higher emesis rate than the control group (RR: 4.486, 95%CI: 2.263-8.891, P < 0.001). CONCLUSION Morphine effectively suppresses the inhibition effect of P2Y12 platelet inhibitors in patients with AMI.
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9
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Charpentier S, Galinski M, Bounes V, Ricard-Hibon A, El-Khoury C, Elbaz M, Ageron FX, Manzo-Silberman S, Soulat L, Lapostolle F, Gérard A, Bregeaud D, Bongard V, Bonnefoy-Cudraz E. Nitrous oxide/oxygen plus acetaminophen versus morphine in ST elevation myocardial infarction: open-label, cluster-randomized, non-inferiority study. Scand J Trauma Resusc Emerg Med 2020; 28:36. [PMID: 32398160 PMCID: PMC7218609 DOI: 10.1186/s13049-020-00731-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
Background Studies have shown disparate results on the consequences of morphine use in ST-segment elevation myocardial infarction (STEMI). No study has evaluated alternative treatments that could be at least non-inferior to morphine without its potentially damaging consequences for myocardial function and platelet reactivity. The aim of this study was to evaluate whether nitrous oxide/oxygen plus intravenous acetaminophen (NOO-A) is non-inferior to morphine to control chest pain in STEMI patients. Methods This multicenter, open-label, cluster-randomized, controlled, non-inferiority study compared NOO-A with morphine in 684 prehospital patients with ongoing suspected STEMI of < 12 h duration and a pain rating score ≥ 4. The primary endpoint was the proportion of patients achieving pain relief (numeric rating score ≤ 3) after 30 min. Secondary safety endpoints included serious adverse events and death at 30 days. Results The median baseline pain score was 7.0 in both groups. The primary endpoint occurred in 51.7% of the NOO-A group and 73.6% of the morphine group (absolute risk difference − 21.7%; 95% confidence interval − 29.6 to − 13.8). At 30 days, the rate of serious adverse events was 16.0 and 18.8% in the NOO-A and morphine groups respectively (p = NS). The rate of death was 1.8% (NOO-A group) and 3.8% (morphine group) (p = NS). Conclusion Analgesia provided by NOO-A was inferior to morphine at 30 min in patients with acute STEMI in the prehospital setting. Rates of serious adverse events did not differ between groups. Trial registration ClinicalTrials.gov: NCT02198378.
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Affiliation(s)
- Sandrine Charpentier
- Emergency Department, Toulouse University Hospital, INSERM UMR 1027, University Toulouse III Paul Sabatier, Toulouse, France. .,Emergency Department, Rangueil University Hospital, 1 Av. Jean Poulhès, 31059, Toulouse, France.
| | - Michel Galinski
- Emergency Department - SAMU 33, CHU de Bordeaux; INSERM U1219 - Injury Epidemiology Transport Occupation" team, University Bordeaux II, 33000, Bordeaux, France
| | - Vincent Bounes
- SAMU31, Toulouse University Hospital; University Toulouse III Paul Sabatier, Toulouse, France
| | - Agnès Ricard-Hibon
- Pôle Emergency Department, SAMU - Centre Hospitalier René Dubos Pontoise, 95300, Pontoise, France
| | - Carlos El-Khoury
- Emergency Department and RESCUe Network, Lucien Hussel Hospital, Vienne, France.,Univ. Lyon, Claude Bernard Lyon 1 University, HESPER EA, 7425, Lyon, France
| | - Meyer Elbaz
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | | | - Stéphane Manzo-Silberman
- Cardiology department, Lariboisire Hospital, APHP, Paris, France.,Paris VII University UMRS 942, Paris, France
| | - Louis Soulat
- SAMU 35 SMUR Urgences adultes, Centre Hospitalier Universitaire Rennes, Université Rennes 1, Rennes, France
| | - Frédéric Lapostolle
- SAMU 93 - UF Recherche-Enseignement-Qualité Université Paris 13, Sorbonne Paris Cité, Inserm U942 Hôpital Avicenne, AP-HP, 125, rue de Stalingrad, 93009, Bobigny, France
| | - Alexandre Gérard
- Hospices Civils de Lyon SAMU 69 - Hôpital Édouard HERRIOT 5, place d'Arsonval, 69437, LYON Cedex 03, France
| | | | - Vanina Bongard
- Department of Epidemiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Department of Public Health, Université Toulouse 3; UMR 1027 INSERM - Université Toulouse 3, Toulouse, France
| | - Eric Bonnefoy-Cudraz
- Hôpital cardiologique Louis-Pradel, 69500, Lyon, France.,Université Lyon-1, 69100, Lyon, France
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Bartko J, Schoergenhofer C, Schwameis M, Wadowski P, Kubica J, Jilma B, Hobl EL. Morphine Interaction with Aspirin: a Double-Blind, Crossover Trial in Healthy Volunteers. J Pharmacol Exp Ther 2018. [PMID: 29540563 DOI: 10.1124/jpet.117.247213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aspirin is a cornerstone in the antiplatelet therapy for acute coronary syndromes. Coadministration of morphine may potentially influence the intestinal absorption, pharmacokinetics, and pharmacodynamics, as seen with P2Y12 inhibitors. In this trial, healthy volunteers were randomized to receive morphine (5 mg, i.v. bolus injection) at one of seven different time points before, after, or with aspirin (162 mg, p.o.) in a double-blind, placebo-controlled fashion. After a 14-day washout, subjects received placebo instead of morphine. Pharmacokinetics were determined by liquid chromatography, and aspirin's effects were measured by platelet function tests (whole-blood platelet aggregation: multiplate, platelet plug formation: PFA-100). Morphine increased the total acetylsalicylic acid exposure by 20% compared with placebo when given simultaneously with aspirin, whereas Cmax and tmax were not altered. Morphine had no significant effect on aspirin-induced platelet inhibition. In contrast to coadministration with P2Y12 inhibitors, morphine appears to have negligible interaction with aspirin.
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Affiliation(s)
- Johann Bartko
- Department of Clinical Pharmacology, Medical University of Vienna (J.B., C.S., M.S., P.W., B.J., E.-L.H.), and Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling (J.B.), Vienna, Austria; and Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (J.K.)
| | - Christian Schoergenhofer
- Department of Clinical Pharmacology, Medical University of Vienna (J.B., C.S., M.S., P.W., B.J., E.-L.H.), and Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling (J.B.), Vienna, Austria; and Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (J.K.)
| | - Michael Schwameis
- Department of Clinical Pharmacology, Medical University of Vienna (J.B., C.S., M.S., P.W., B.J., E.-L.H.), and Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling (J.B.), Vienna, Austria; and Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (J.K.)
| | - Patricia Wadowski
- Department of Clinical Pharmacology, Medical University of Vienna (J.B., C.S., M.S., P.W., B.J., E.-L.H.), and Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling (J.B.), Vienna, Austria; and Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (J.K.)
| | - Jacek Kubica
- Department of Clinical Pharmacology, Medical University of Vienna (J.B., C.S., M.S., P.W., B.J., E.-L.H.), and Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling (J.B.), Vienna, Austria; and Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (J.K.)
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna (J.B., C.S., M.S., P.W., B.J., E.-L.H.), and Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling (J.B.), Vienna, Austria; and Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (J.K.)
| | - Eva-Luise Hobl
- Department of Clinical Pharmacology, Medical University of Vienna (J.B., C.S., M.S., P.W., B.J., E.-L.H.), and Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling (J.B.), Vienna, Austria; and Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland (J.K.)
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Giannopoulos G, Deftereos S, Kolokathis F, Xanthopoulou I, Lekakis J, Alexopoulos D. P2Y12 Receptor Antagonists and Morphine: A Dangerous Liaison? Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.116.004229. [PMID: 27586412 DOI: 10.1161/circinterventions.116.004229] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
P2Y12 receptor antagonists, concurrently administered with aspirin in what has come to be commonly called dual antiplatelet therapy, are a mainstay of treatment for patients with acute coronary syndromes. Morphine, on the contrary, is a commonly used drug in the acute phase of acute coronary syndromes to relieve pain-with the added potential benefit of attenuating acutely raised sympathetic tone. In current guidelines, though, morphine is recommended with decreasing strength of recommendation. One reason is that it raises concern regarding the potentially significant interaction with antiplatelet agents, leading to impaired inhibition of platelet activation. In any case, it is still considered a mandatory part of the inventory of available medications in prehospital acute myocardial infarction management. The goal of the present review is to present published evidence on morphine and its potential interactions with P2Y12 receptor antagonists, as well as on the central issue of whether such interactions may underlie clinically significant effects on patient outcomes.
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Affiliation(s)
- Georgios Giannopoulos
- From the Second Department of Cardiology, National and Kapodistrean University of Athens, Attikon University Hospital, Greece (G.G., S.D., F.K., J.L., D.A.); and Department of Cardiology, University of Patras, University Hospital of Rio, Greece (I.X.).
| | - Spyridon Deftereos
- From the Second Department of Cardiology, National and Kapodistrean University of Athens, Attikon University Hospital, Greece (G.G., S.D., F.K., J.L., D.A.); and Department of Cardiology, University of Patras, University Hospital of Rio, Greece (I.X.)
| | - Fotios Kolokathis
- From the Second Department of Cardiology, National and Kapodistrean University of Athens, Attikon University Hospital, Greece (G.G., S.D., F.K., J.L., D.A.); and Department of Cardiology, University of Patras, University Hospital of Rio, Greece (I.X.)
| | - Ioanna Xanthopoulou
- From the Second Department of Cardiology, National and Kapodistrean University of Athens, Attikon University Hospital, Greece (G.G., S.D., F.K., J.L., D.A.); and Department of Cardiology, University of Patras, University Hospital of Rio, Greece (I.X.)
| | - John Lekakis
- From the Second Department of Cardiology, National and Kapodistrean University of Athens, Attikon University Hospital, Greece (G.G., S.D., F.K., J.L., D.A.); and Department of Cardiology, University of Patras, University Hospital of Rio, Greece (I.X.)
| | - Dimitrios Alexopoulos
- From the Second Department of Cardiology, National and Kapodistrean University of Athens, Attikon University Hospital, Greece (G.G., S.D., F.K., J.L., D.A.); and Department of Cardiology, University of Patras, University Hospital of Rio, Greece (I.X.)
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Crea F, Binder RK, Lüscher TF. The year in cardiology 2016: acute coronary syndromes. Eur Heart J 2017; 38:154-164. [PMID: 28043974 DOI: 10.1093/eurheartj/ehw620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/02/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular and Thoracic Sciences, Institute of Cardiology, Catholic University, Largo A. Gemelli, 800168 Rome, Italy
| | - Ronald K Binder
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemstrasse 100, 8091 Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemstrasse 100, 8091 Zurich, Switzerland
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McCarthy CP, Mullins KV, Sidhu SS, Schulman SP, McEvoy JW. The on- and off-target effects of morphine in acute coronary syndrome: A narrative review. Am Heart J 2016; 176:114-21. [PMID: 27264228 DOI: 10.1016/j.ahj.2016.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/12/2016] [Indexed: 12/31/2022]
Abstract
With potent analgesic properties, perceived hemodynamic benefits and limited alternatives, morphine is the analgesic mainstay for patients with nitrate resistant chest pain due to acute Myocardial Infarction (MI). However, observational data suggest that morphine administration during MI may have negative consequences. While vomiting, hypotension and respiratory depression are established side effects, recent reports have demonstrated attenuated and delayed oral anti-platelet agent absorption, as well as suboptimal reperfusion after MI, all of which may translate into adverse cardiovascular outcomes. These data have resulted in reduced support for morphine in recent European and U.S. clinical practice guidelines for MI; despite the absence of any prospective randomized outcomes trials addressing this question. As such, randomized trials are now necessary to confirm whether or not morphine, which is administered in up to 30% of MI cases, causes adverse clinical outcomes in these patients. However, given that placebo-controlled randomized trial designs evaluating morphine in MI are limited by an ethical requirement for appropriate analgesia, alternative investigational approaches may be necessary. In this article we review the updated evidence for morphine in MI and outline novel strategies that may facilitate future investigation of this clinical dilemma.
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Morphine in the setting of acute myocardial infarction: pros and cons. Am J Emerg Med 2016; 34:746-8. [PMID: 26874396 DOI: 10.1016/j.ajem.2016.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 01/13/2016] [Indexed: 11/20/2022] Open
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Kubica J, Adamski P, Ostrowska M, Sikora J, Kubica JM, Sroka WD, Stankowska K, Buszko K, Navarese EP, Jilma B, Siller-Matula JM, Marszałł MP, Rość D, Koziński M. Morphine delays and attenuates ticagrelor exposure and action in patients with myocardial infarction: the randomized, double-blind, placebo-controlled IMPRESSION trial. Eur Heart J 2016; 37:245-52. [PMID: 26491112 PMCID: PMC4712351 DOI: 10.1093/eurheartj/ehv547] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 08/23/2015] [Accepted: 09/23/2015] [Indexed: 02/05/2023] Open
Abstract
AIMS The currently available data indicate a drug-drug interaction between morphine and oral P2Y12 receptor inhibitors, when administered together. The aim of this trial was to assess the influence of infused morphine on pharmacokinetics and pharmacodynamics of ticagrelor and its active metabolite (AR-C124910XX) in patients with acute myocardial infarction. METHODS AND RESULTS In a single-centre, randomized, double-blind trial, patients were assigned in a 1:1 ratio to receive intravenously either morphine (5 mg) or placebo, followed by a 180 mg loading dose of ticagrelor. Pharmacokinetics was determined with liquid chromatography tandem mass spectrometry and ticagrelor antiplatelet effects were measured with up to three different platelet function tests: vasodilator-stimulated phosphoprotein phosphorylation assay, multiple electrode aggregometry and VerifyNow. The pharmacokinetic and pharmacodynamic assessment was performed in 70 patients (35 in each study group). Morphine lowered the total exposure to ticagrelor and its active metabolite by 36% (AUC(0-12): 6307 vs. 9791 ng h/mL; P = 0.003), and 37% (AUC(0-12): 1503 vs. 2388 ng h/mL; P = 0.008), respectively, with a concomitant delay in maximal plasma concentration of ticagrelor (4 vs. 2 h; P = 0.004). Multiple regression analysis showed that lower AUC(0-12) values for ticagrelor were independently associated with the administration of morphine (P = 0.004) and the presence of ST-segment elevation myocardial infarction (P = 0.014). All three methods of platelet reactivity assessment showed a stronger antiplatelet effect in the placebo group and a greater prevalence of high platelet reactivity in patients receiving morphine. CONCLUSIONS Morphine delays and attenuates ticagrelor exposure and action in patients with myocardial infarction. ClinicalTrials.gov Identifier: NCT02217878.
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Affiliation(s)
- Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Piotr Adamski
- Department of Principles of Clinical Medicine, Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, Bydgoszcz 85-094, Poland
| | - Małgorzata Ostrowska
- Department of Principles of Clinical Medicine, Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, Bydgoszcz 85-094, Poland
| | - Joanna Sikora
- Department of Pharmacology and Therapy, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Julia Maria Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Wiktor Dariusz Sroka
- Department of Medicinal Chemistry, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Katarzyna Stankowska
- Department of Pathophysiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Katarzyna Buszko
- Department of Theoretical Foundations of Biomedical Science and Medical Informatics, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Eliano Pio Navarese
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland Department of Internal Medicine, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Michał Piotr Marszałł
- Department of Medicinal Chemistry, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Danuta Rość
- Department of Pathophysiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Marek Koziński
- Department of Principles of Clinical Medicine, Collegium Medicum, Nicolaus Copernicus University, 9 Skłodowskiej-Curie Street, Bydgoszcz 85-094, Poland
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