Guidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction

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This guidance from NICE makes recommendations about which thrombolytic drugs should be used for patients who have had a heart attack.

For treatment with thrombolytic drugs in hospital, NICE recommends that doctors should take the following factors into account when deciding which thrombolytic drug (alteplase, reteplase, streptokinase or tenecteplase) to use for an individual patient.

  • The benefits and risks, such as stroke, that the thrombolytic drugs are likely to have for the individual patient. 
  • It is normal practice in the UK that patients who have been treated with streptokinase before should not be treated with it again. 
  • How the hospital arrangements are set up to ensure that thrombolysis is given as soon as possible after the patient has been admitted.

NICE has also made recommendations about which drugs to use where emergency care arrangements for people having a heart attack include giving thrombolytic drugs before the patient reaches hospital – for example, this might be the setup for communities a long way from a hospital with emergency facilities. Because of the difficulties of setting up an intravenous infusion of a thrombolytic drug somewhere other than in hospital, NICE recommends that in these circumstances a thrombolytic drug given by intravenous injection (reteplase or tenecteplase) should be used.

  • In January 2006, following consultation, the Institute decided to make this guidance 'static.' This means that the guidance remains in force and has no scheduled review date. See the review decision, under 'Background information', for further details

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