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.

Your responsibility

The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.