The Pharmaceutical Journal
Vol 269 No 7222 p633
2 November 2002

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NICE makes recommendations for use of thrombolytic drugs for acute MI

Bolus drugs should be used to treat acute myocardial infarction (MI) when patients are treated before being admitted to hospital, according to new guidance from the National Institute for Clinical Excellence.

It says that, where pre-hospital delivery of thrombolytic drugs is considered to be beneficial, for example, because of the inaccessibility of acute hospital facilities, reteplase (Rapilysin) or tenecteplase (Metalyse) should be the preferred options because they can be given by rapid intravenous (IV) bolus infusion. The two other thrombolytic agents licensed for treatment of acute MI — streptokinase and alteplase (Actilyse) — are given by IV infusion.

In hospital settings, the guidance states that the choice of which thrombolytic drug to use in acute MI should be based on patient need and the hospital's local arrangements for minimising delay in administering thrombolysis. NICE says the choice of drug should also be influenced by current practice, which accepts that people who have already received streptokinase once should not be treated with it again.

Current spend on thrombolytics in England and Wales is estimated to be £13–26m. However, NICE says it is likely that there will be substantial costs associated with further expansion and introduction of pre-hospital thrombolysis, which it says is becoming more common.

Dr Anton Van Dellen, medical adviser to Staffordshire Ambulance Service NHS Trust, said: "[The guidance] will improve the standard of care for people who have had a heart attack. They should now be able to receive the right treatment at the right time, which could mean the difference between life and death."

He added that Staffordshire paramedics had achieved good results with the bolus drug reteplase since they began using it two years ago.

The guidance, which provides recommendations on the use of alteplase, reteplase, tenecteplase and streptokinase in patients with acute MI in pre-hospital and hospital settings, can be viewed on the NICE website (www.nice.org.uk).