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Assessment of the practicality and safety of thrombolysis with anistreplase given by general practitioners
P Hannaford1, R Vincent, S Ferry
1Royal College of General Practitioners Manchester Research Unit.
Insights
General practitioners can safely administer anistreplase for acute myocardial infarction. However, contraindications and practical challenges may limit its use in community settings.
Area of Science:
- Cardiology
- General Practice
- Pharmacology
Background:
- Guidelines recommend timely thrombolysis for acute myocardial infarction (AMI).
- General practitioners (GPs) are increasingly involved in administering thrombolytic agents.
- This study evaluates anistreplase use by GPs in AMI management.
Purpose of the Study:
- To assess the practicality of using anistreplase by general practitioners.
- To evaluate the safety of anistreplase administration in primary care settings.
- To understand the factors influencing anistreplase use in acute myocardial infarction.
Main Methods:
- An observational study involving 805 UK general practices.
- Recruited 3383 patients with suspected myocardial infarction.
- Compared GPs using anistreplase (user group) with those not using it (comparison group).
Main Results:
- Only 310 patients received anistreplase in the community.
- GPs demonstrated high diagnostic accuracy and safe anistreplase administration.
- Few patients received anistreplase with contraindications; bleeding risks were recognized.
- Complications of AMI were managed appropriately.
Conclusions:
- General practitioners can appropriately and safely use anistreplase in early AMI management.
- Contraindications and practicalities (diagnosis, administration) can limit anistreplase usage.
- Anistreplase is a safe option for GPs in managing acute myocardial infarction.
Background:
Recent guidelines recommend that patients with obvious acute myocardial infarction receive thrombolysis, unless contraindicated, within 60-90 minutes of summoning assistance. If this target is to be achieved, an increasing number of general practitioners are likely to be involved in the administration of thrombolytic agents.
Aim:
This study aimed to assess the practicality and safety of thrombolysis with anistreplase when given by general practitioners.
Method:
An observational study was conducted in 805 general practices throughout the United Kingdom. Between March 1991 and September 1992, a total of 3383 patients with a clinical diagnosis of myocardial infarction were recruited--888 by 344 general practitioners who wished to include anistreplase in their management of myocardial infarction ('user' group) and 2495 by 776 general practitioners who did not wish to use anistreplase but who were willing to provide information about their cases ('comparison' group).
Results:
More than half the patients were seen within two hours of onset of symptoms. A high frequency of contra-indications to thrombolysis, diagnostic uncertainty, and other, mainly practical, reasons limited the number of occasions on which anistreplase was administered. Thus, only 310 patients were given anistreplase in the community. The general practitioners in the study used anistreplase safely. Their diagnostic accuracy was high (of the 310 patients given anistreplase 69% had a definite, possible or probably myocardial infarction, 4% a definite non-cardiac diagnosis), the number of patients given anistreplase in spite of a documented contraindication was small (seven patients), and the doctors appeared to be aware of potential bleeding problems associated with thrombolysis. In all cases, the complications of acute myocardial infarction appeared to be managed appropriately.
Conclusion:
General practitioners can use anistreplase both appropriately and safely in the early management of acute myocardial infarction. Recognized contraindications to thrombolysis and practicalities of diagnosis and drug administration may, however, limit the number of occasions on which anistreplase is used.