Platelet Reactivity With Fentanyl, Morphine, or no Narcotic

A Comparison of PLAtelet Response to Aspirin Between Emergency Department Patients With Chest Pain Receiving Fentanyl or Morphine (PLAAFM)

The goal is to determine whether fentanyl and morphine have similar effects in reducing aspirin's effect upon platelets in emergency department patients with chest discomfort. Morphine has been shown to worsen outcomes in heart attack patients due to reduction of oral anti-platelet agent effectiveness and so many providers have switches to using fentanyl. However, it is largely unknown whether fentanyl has similar effects.

Patients presenting to the emergency department with chest discomfort who are being administered aspirin will be offered enrollment in this study. At the time of their zero and two hour troponin we will also draw platelet aggregration studies to determine the effects of aspirin upon platelets. Narcotic medicines slow the absorption of aspirin. Morphine has therefore been shown to decrease the effectiveness of aspirin. Many providers therefore use fentanyl instead, however little is known about the effects of fentanyl upon aspirin. We will therefore compare the platelet reactivity of patients receiving morphine, fentanyl, or no narcotics

Inclusion Criteria:

• Adult Emergency Department patients undergoing 0 and 2 hour troponin testing
• administered aspirin within 30 minutes of the initial blood draw.
• patient presented via private vehicle
• provide informed consent
• over the age of 18

Exclusion Criteria:

• Patients not expected to get a 2 hour troponin;
• patients already on aspirin, clopidogrel, or stronger anti-coagulants;
• patients who arrived via EMS (Emergency Medical Services) given it can be difficult to find the run reports to determine whether patient received fentanyl in the pre-hospital period;
• pregnant patients;
• patients on chronic narcotics;
• patients already once enrolled in this study,
• inability to provide consent in English