An audit of thrombolysis and adjunct drug use in acute myocardial infarction

This study looked at outcomes of acute myocardial infarction patients following administration of streptokinase or alteplase. For 150 patients (155 thrombolytic drug administrations), the median time delay between onset of symptoms and thrombolytic therapy was 3.6 hours. Only 65 per cent of streptokinase-treated patients tolerated the recommended dose, compared with 85 per cent of those treated with alteplase. Aspirin usage was uncommon (9 per cent) prior to admission but rose to 68 per cent on discharge. However, β-blocker usage only increased from 16 per cent to 24 per cent. Parenteral and oral anticoagulant usage was numerically greater in the alteplase group. There was no significant difference between streptokinase or alteplase in the incidence of any observed adverse effects. There were no allergic type reactions in the alteplase group. The incidence of such reactions in the streptokinase group was not affected by pre-treatment with anti-allergy drugs. Patients in both thrombolytic drug groups experienced similar falls in blood pressure but severe hypotension was more common in the streptokinase group.