Use of alteplase for myocardial infarction in two community hospitals

A drug-use evaluation (DUE) of i.v. alteplase for the treatment of acute myocardial infarction (AMI) in two community hospitals is described. From November 1987 to June 1989, all 118 patients who were treated with i.v. alteplase for suspected AMI at two large community hospitals were monitored daily to determine patterns of use of alteplase, clinical outcomes, the hospital time needed to diagnose AMI and begin therapy, and the pharmacy time needed to prepare and deliver alteplase. Patient inclusion criteria were (1) chest discomfort of less than six hours' duration and unrelieved by nitroglycerin or nifedepine, (2) age less than 75 years, and (3) electrocardiographic evidence of transmural AMI. Each patient received alteplase 100 mg i.v. and i.v. heparin therapy; 58% of the patients were also given aspirin 81-325 mg/day. The data for the two institutions were combined; there was no control group. The mean +/- S.D. age of patients was 58 +/- 10 years; 75% were men. Treatment began at a mean of 181 +/- 111 min after symptom onset, including the time it took for the 96 patients whose symptoms began outside the hospital to reach the hospital. The mean hospital time required to initiate treatment was 89 +/- 65 min. The mean pharmacy time required to prepare and deliver alteplase was 12 +/- 6 min. The in-hospital mortality rate was 6.4%, the rate of patency of the infarct-related artery was 85% at a mean of seven days in the 95 patients who underwent coronary angiography, and the nonfatal reinfarction rate was 1.8%. Severe bleeding complications occurred in only two patients, and no patient suffered a stroke.(ABSTRACT TRUNCATED AT 250 WORDS)