VIEWS & REVIEWS

Which factors influence administration of thrnmbolytics in MI?

Women. older patients (mean 68 years of age), and those who arrived at the hospitaJ relatively late after onset of symptoms (mean 2.7 hours) were less likely to receive thrombolytic therapy, according to the findings of a muhicenlre, US study. The study authors evaluated data from 212 990 patients with myocardial infarction and 904 hospitals included in the National Registry of Myocardial Infarction.

In this cohort of patients, time to administration of alteplase was longer for women. older patients, and those who arrived at the hospita1 during the night. However, mean time to treatment, which decreased noticeably from 1990 to 1993. did not appear to be influenced by the size of the hospital, say the investigators.

They found that. despite considerable education about the benefits of early treatment with thrombolytic therapy, > 50% of patients waited more than 2 hours before seeking medical care and 25% of patients delayed by as much as 4.7 hours. 28% of patients in the studied cohort received treatment with alteplase.

The study authors point out that delaying the initiation of thrombolytic therapy until the patient's admission to the coronary care unit resulted in substantially longer times to treatment. They reiterate that thrombolytic therapy should be initiated in the emergency department. and should only be administered in the coronary care unit when the patient is directly admitted there. MayIIard C. Wca ..... WD. ~ C. Natiocal Rl:JiSlI'Y of Myocardi&I WarWoft. F.:IUrt iDfIlXDciD& !be time 10 administtatioD ~ thrombolytic lbenpy willi ~ tisUle pllsmlno&'" Kti_ (du. &I:m * N~ Rl:gistry ofMyocardiallDtamian). AmericaII.Joo.LrW ofCulOOloo 76: 548·5S2, IS Scp 1995 _

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INPHARMA- 30 s., 1l1li6