NICE 2002/054
Issued: 30 October 2002


PRESS RELEASE

NICE issues guidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction

 

The National Institute for Clinical Excellence has today issued guidance to the NHS in England and Wales on the use of thrombolytic drugs - drugs which dissolve potentially life-threatening blood clots - in patients who have had a major heart attack. The guidance recommends that:

  • The choice of which drug - either alteplase, reteplase, streptokinase or tenecteplase - to use in hospital should be based upon the needs of the patient and the hospital's local arrangements.

  • When thrombolytic drugs are used in pre-hospital settings, such as ambulances, then reteplase or tenecteplase should be used.

A major heart attack (or acute myocardial infarction (AMI)) occurs when a blood clot blocks one of the large blood vessels that carry oxygen-rich blood to the heart. The blockage stops blood reaching part of the heart muscle and the part of the heart affected can become permanently damaged. The highest risk of death from AMI is within the first hour of the onset of symptoms. Thrombolytic drugs break down the blood clot so that blood flow to the heart muscle can be restored to prevent further damage and assist healing.

Andrea Sutcliffe, executive lead for this appraisal said: "Around a quarter of a million people have a major heart attack in England and Wales each year - and around one-third of deaths from heart attacks happen in the first hour. By providing guidance on the use of these clot-busting drugs, before patients reach hospital and in hospital, this will help patients to access the best possible treatment in the critical first hour after the onset of symptoms."

Ends

Notes to Editors

About NICE

1. NICE is part of the NHS. It is the independent organisation responsible for providing national guidance on treatments and care for those using the NHS in England and Wales. Its guidance is for healthcare professionals and patients and their carers to help them make decisions about treatment and healthcare. For further information about NICE you can visit www.nice.org.uk.
   
2.

NICE produces guidance in three areas of health:

  • the use of new and existing medicines and treatments within the NHS in England and Wales - technology appraisals.
  • the appropriate treatment and care of patients with specific diseases and conditions within the NHS in England and Wales - clinical guidelines.
  • the safety and usefulness of an interventional procedure, for example a new type of surgery -interventional procedures.

NICE also funds four enquiries that undertake research into the way patients are treated to identify ways of improving the quality of care (the investigations are known as confidential enquiries).

3.

NICE guidance and recommendations are prepared by independent groups that include professionals working in the NHS and people who are familiar with the issues affecting patients and carers.

   
About technology appraisals
   
4.

Technology appraisals are recommendations on the use of new and existing medicines and treatments within the NHS in England and Wales, such as:

  • medicines (for example, drugs)
  • medical devices (for example, hearing aids or inhalers)
  • diagnostic techniques (tests used to identify diseases)
  • surgical procedures (for example, repairing hernias)
  • health promotion activities (for example, patient education models for diabetes).
5. Our technology appraisal recommendations are prepared by an independent Committee, who include healthcare professionals working in the NHS and people who are familiar with the issues affecting patients and carers. The Committee considers the evidence on the clinical and cost effectiveness of the technology - this includes hearing the views of, and evidence from, clinical health professionals, experts and patients.
   
6. NHS organisations in England and Wales have to make the resources and facilities available to enable NICE guidance to be implemented. In January 2002 the Government announced a legal obligation for the NHS to provide funding for treatments and drugs recommended by NICE as a part of its technology appraisals work.
   
What has NICE recommended about the use drugs for early thrombolysis in the treatment of acute myocardial infarction?
   
7. 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 tenacteplase) to use for an individual patient
  • The benefits and risks, such as stroke, that the thrombolytic drugs are likely to have for an individual patient
  • That 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
8. 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 because of population geography or because of the distance from a hospital with emergency facilities:
  • Because of the difficulties of setting up an intravenous infusion of a thrombolytic drug somewhere other than in a hospital, NICE recommends that in these circumstances a thrombolytic drug given by intravenous injection (reteplase or tenecteplase) should be used.
What is the likely resource impact of this guidance for the NHS?
   
9.

It is very difficult to estimate with any certainty the likely increase in drug costs to the NHS as a result of this guidance - estimates vary from between £9m and £19m depending on the methods used to estimate current costs. In addition, there are substantial costs associated with the introduction of pre-hospital thrombolysis. These include the costs of additional equipment, training and potentially longer ambulance time spent treating patients with AMI.