Thrombolytics-a drug utilization review in a district general hospital

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.