Is prehospital thrombolysis feasible? This study says 'yes'

' ... Prehospltal thrombolysis Is feasible and safe If the mobile care unit team has been speclfkal/y trained for diagnosis of acute All [myocardial Infarction]. •

149/155 patients with acute chest pain diagnosed at home as having an acute myocardial infarction (MI) by a physician in a mobile care unit, had the diagnosis confirmed in hospital. In addition, the 6 patients with false positive diagnoses would not have received thrombolysis because the physician was not certain the diagnosis was correct. Therefore, the risk of thrombolytic therapy being given inappropriately was considered to be low. Subsequently, patients with suspected acute myocardial infarction were randomised to anistreplase 30U at home (n = 57), or placebo at home and anistreplase in the hospital (43).

The emergency diagnosis was considered correct by hospital-based cardiologists in 97/100 patients. Patients treated at home received anistreplase approximately 1 hour earlier than patients treated in hospital. The time to arrival at the coronary care unit did not differ between patients included in the study administered an injection at home and non-included patients admitted directly to hospital. No bleeding complications occurred in the prehospital phase. Thus, it appears that prehospital thrombolysis can be administered without significant risk of inappropriate administration, delay in admission, or haemorrhage. Whether this strategy can improve morbidity and mortality (vs inpatient administration of thrombolysis) remains to be determined. Castaigne AD, Herve c, Duval-Moulin A-M, Ga~lard M, Dubois-Rande J-L, et aI. Prehospital use of APSAC: results of a piacebo-controlled study. American Journal of Cardiology 64: 3OA-33A, 5 Jul 1989 121

6 INPHARMA· 29 Jul 1989 0156-2703/89/0729-0006/0$07.00/0 © ADIS Press