2 VIEWS & REVIEWS

Infonned consent for thrombolytD Before thrombolytics are administered in cases

of MI, physicians are obliged to inform patients of the small chance that they may subsequently require a blood transfusion, says Dr Jeremy Sugarman and colleagues from the Johns Hopkins University School of Medicine, Baltimore, US. Patient preferences can then be included in decisions regarding thrombolytic therapy.

Despite the widespread use of thrombolytics in MI, these agents are associated with a small risk (0.6-4%) of haemotrhagic complications requiring blood transfusion. Although the actual risk of morbidity associated with transfusion is low (0.018-0.12%) and insignificant compared with the benefits of thrombolytic therapy, patients may perceive the risk to be much greater. Nevertheless, it is the physicians' responsibility that patients receive adequate information and be involved in decision-making.

How much infonnation? The amount of information supplied to patients

will be dictated by the patient's condition and any prior treatment decisions made by the patient. However, when patients are incapable of making any decisions, it is then acceptable for physicians to administer the appropriate therapy without consent.

Dr Sugarman and colleagues consider that the formalised informed consent process which is commonly used prior to surgical procedures which may lead to a need for blood transfusions, may also be appropriate in the case of thrombolytic therapy. Sugannan J. Powe NR. Guerci AD. Levine DM. Facts and fears regarding blood transfusions in decision making for thrombolytic therapy. American HeartJournaJ 126: 494-499. Aug 1993 8002198>2

11 Sep 1993 INPHARMAIII> ISSN 0156-2703l9310911-OO2I$1.ooc Adl. International Ltd