1 Recommendations

This guidance provides recommendations on the selection of thrombolytic drugs in patients with acute myocardial infarction (AMI). Recommendations are made in relation to the use of the drugs in hospital and pre-hospital settings. The guidance does not compare hospital and pre-hospital models of delivering thrombolysis.


It is recommended that, in hospital, the choice of thrombolytic drug (alteplase, reteplase, streptokinase or tenecteplase) should take account of:

  • the likely balance of benefit and harm (for example, stroke) to which each of the thrombolytic agents would expose the individual patient

  • current UK clinical practice, in which it is accepted that patients who have previously received streptokinase should not be treated with it again

  • the hospital's arrangements for reducing delays in the administration of thrombolysis.


Where pre-hospital delivery of thrombolytic drugs is considered a beneficial approach as part of an emergency-care pathway for AMI (for example, because of population geography or the accessibility of acute hospital facilities), the practicalities of administering thrombolytic drugs in pre-hospital settings mean that the bolus drugs (reteplase or tenecteplase) are recommended as the preferred option.