Document Detail


Assessment of the practicality and safety of thrombolysis with anistreplase given by general practitioners.
MedLine Citation:
PMID:  7612317     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
P Hannaford; R Vincent; S Ferry; S Hirsch; C Kay
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The British journal of general practice : the journal of the Royal College of General Practitioners     Volume:  45     ISSN:  0960-1643     ISO Abbreviation:  Br J Gen Pract     Publication Date:  1995 Apr 
Date Detail:
Created Date:  1995-08-24     Completed Date:  1995-08-24     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  9005323     Medline TA:  Br J Gen Pract     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  175-9     Citation Subset:  IM    
Affiliation:
Royal College of General Practitioners Manchester Research Unit.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anistreplase / adverse effects,  therapeutic use*
Controlled Clinical Trials as Topic
Family Practice / methods*
Female
Humans
Male
Middle Aged
Myocardial Infarction / drug therapy*
Physician's Role
Thrombolytic Therapy* / adverse effects,  contraindications
Time Factors
Chemical
Reg. No./Substance:
81669-57-0/Anistreplase
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