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Updated: Jun 26, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Thrombolytics--a drug utilization review in a district general hospital
1Borders General Hospital, Melrose, Roxburghshire, UK.
Insights
This retrospective drug utilization review found that thrombolysis for myocardial infarction (MI) largely followed hospital guidelines. However, some patients did not receive treatment due to atypical presentation, with slightly higher mortality in untreated cases.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Retrospective drug utilization review (DUR) assesses adherence to clinical trial recommendations in practice.
- Evaluating adherence to hospital guidelines for thrombolysis in myocardial infarction (MI) is crucial for patient care.
Purpose of the Study:
- To assess whether thrombolysis administration for myocardial infarction (MI) aligned with established hospital protocols.
- To identify reasons for non-administration of thrombolytic therapy in MI patients.
Main Methods:
- A retrospective drug utilization review (DUR) was conducted.
- Data from patients diagnosed with myocardial infarction (MI) admitted to Borders General Hospital between April and December 1993 were analyzed.
Main Results:
- 48% of patients received thrombolysis (52% of definite MI cases).
- Atypical presentation, particularly ECG findings inconsistent with guidelines, was the primary reason for withholding thrombolysis.
- Mortality rates at discharge and 6 months were slightly higher in patients who did not receive thrombolytic therapy.
Conclusions:
- Thrombolytic drug use generally adhered to hospital guidelines for MI treatment.
- In two instances, the use of alteplase over streptokinase lacked clear justification.
- Appropriate reasons existed for all cases where thrombolytic therapy was not administered.
Background:
Retrospective drug utilization review (DUR) can be of benefit in determining the extent to which recommendations derived from clinical trials are carried out in practice.
Objective:
To determine whether thrombolysis was given in accordance with hospital guidelines.
Method:
A retrospective DUR of the treatment of patients with a diagnosis of myocardial infarction (MI) admitted to Borders General Hospital during April-December 1993 was carried out.
Results:
Forty-eight per cent of these patients received thrombolysis, representing 52% of all patients with a definite diagnosis of MI. The most frequent reason for thrombolysis not being given was atypical presentation, particularly ECG changes not in accordance with those described in the hospital guidelines for diagnosis of MI. Contraindications and late presentations were very few in number. Appropriate reasons were identified for all patients who did not receive thrombolytic therapy. Mortality both at discharge and at 6 months was slightly greater in these patients than in treated patients.
Conclusion:
Thombolytic drugs were used in line with the hospital guidelines in most cases, although there was no identifiable reason for the use of alteplase instead of streptokinase in two cases.
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