Overall use of thrombolytics after acute myocardial infarction is low
Alteplase is a recently introduced thrombolytic agent. Considerable controversy has been generated over the choice of which thrombolytic agent 10 use. Therefore, a survey of prescribing patterns of thrombolytics in patients with acute myocardial infarction (MI) in 381 hospitals in the USA was conducted. 164 hospitals replied to the Questionnaire.
A mean of 25.5 patients were admitted with acute MI per month. Thrombolytic agents were only used to treat 17% of patients with acute MI, possibly because 66.3~ of hospitals surveyed allowed a maximum of 6 bours to elapse from onset of symptoms before administration of thrombolytics (hospital guidelines had not yet incorporated findinp that the administration of thrombolytic qents can be effective up to 24 hours after the onset of symptoms). 53'" of the hospitals required a cardiology consultation before thrombolytic administration.
Availability of thrombolytics on hospital formularies was studied. Alteplase was the oDly thrombolytic agent available OD the fonnulary in 14.6'11. of hospitals, while alteplase and streptokinase were iDcluded on the fonnulary in 6S.3'b of hospitals, streptokinase aloDe in 3.7'b and urokinase alone in 1.29ft. The decision to include alteplase was based on efficacy profile and physicians' preference, with safety and cost as further considerations.
107 hospitals indicated that they performed prospective or retrospective phannacy-initiated monitoring programmes of patients receiving thrombolytics, and in 87/107 records from > 90% of patients receiving thrombolytics were reviewed by the clinical pharmacist.
ThUs. 'h u bunat;.z 10 .. tW, ;" "i'~ of,1u "'..,.. ,.tlidty ",..,..,. ., ,III I~ ./ ~ ,,, .. of'~ ts i.,.."ts "it. AMIlIIu MI/ tfHfli ... IINNlI ", N ,.,. .. ..,wq ...... . , JUdI ""'* ,....;g 10 N" ttl iMatify Jlllpida- .. ,a.,-"'. ~ 'UI ~awrw:tI.~QUN_'=? ""', The clinical pharmacist may be an important resource to resolve some of these issues.
Gruda TH. Gfftft JA. A IIIItiorlwiOe survty or PftKribi", patlemS tOr thrombolytic ~ in .nn~ myocardill infill't1;on. PbltmIl'Othenpy I(); 1s-41 . Jan 1990 . "
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