The Pharmaceutical Journal
Vol 269 No 7226 p772
30 November 2002

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Thrombolytics safe for ambulance use

A combination of tenecteplase (Metalyse) and unfractionated heparin can be given safely in ambulances, a new trial has shown.

Although the efficacy of these agents has been established, the feasibility of giving antithrombotic regimens before patients have been admitted to hospital has not been demonstrated in a multicentre randomised trial until now. The trial also assessed the use of tenecteplase plus enoxaparin (Clexane) and showed that this combination reduced ischaemic events that occur in hospital. However, it was associated with an increased risk of major bleeding and intracranial haemorrhage compared with tenecteplase plus heparin.

Professor Lars Wallentin, Uppsala University, Sweden, who presented the trial data at the American Heart Association scientific sessions in Chicago last week, said: "There were advantages and disadvantages with the [enoxaparin plus tenecteplase] combination in the ambulance."

The incidence of intracranial haemorrhage increased from 0.97 per cent in patients treated with UFH to 2.2 per cent in patients treated with enoxaparin (P=0.047). "However, these were patients entirely above 75 years of age and almost entirely women," he added.

Professor Wallentin concluded that administration of thrombolytic agents in the ambulance shortens treatment delay but added that further dose finding studies in the elderly and in women were needed for the combination of enoxaparin and tenecteplase.

The National Institute for Clinical Excellence issued guidance on the use of thrombolytic agents in the pre-hospital setting in October (PJ, 2 November, p633).