Domiciliary Thrombolysis Research Articles

Audit of prehospital thrombolysis by general practitioners in peripheral practices in Grampian

BackgroundIn the Grampian region early anistreplase trial (GREAT), domiciliary thrombolysis by general practitioners was associated with a halving of one year mortality compared with hospital administration. However, after completion of...

Impact of resuscitation and thrombolysis on mortality rate from acute myocardial infarction

Our objective was to estimate the saving of life by thrombolysis and resuscitation in acute myocardial infarction (AMI) before and after hospital admission. We studied all 1516 patients admitted to a Scottish teaching hospital in 1990 and 1992 who had a final diagnosis of AMI, and 311 patients enrolled in the Grampian region early anistreplase trial (GREAT). Cardiac arrest occurred in 250 1516 (16%) hospital patients. Of these, 77 (31%) were discharged alive — a saving of 51 lives per thousand cases. 797 (53%) patients received thrombolysis, of whom 114 (14%) died. Assuming the same relative reduction in mortality as in the second international study of infarct survival (ISIS-2; 23%), 34 lives were saved by thrombolytic therapy, representing 22 lives per thousand cases. Of 311 patients in GREAT, 15 (5%) had prehospital cardiac arrest, with 7 patients surviving to discharge (48%) — a saving of 23 lives per thousand cases. Those patients given domiciliary thrombolysis had a one month mortality of 6.7% ( 11 163 ) compared with 12.2% ( 18 148 ) for those receiving hospital thrombolysis — a saving of 55 lives per thousand cases for prehospital thrombolysis. This is additional to 28 lives per thousand estimated for thrombolytic therapy in hospital, totalling 83 lives saved per thousand cases of AMI receiving thrombolytic therapy prehospital. In hospital, more lives were saved by resuscitation than by thrombolytic therapy, but this ratio was reversed in the period before hospital admission. These results emphasise the paramount importance of resuscitation in hospital, and the enhanced efficacy of thrombolysis when given at the earliest opportunity.

Halving of mortality at 1 year by domiciliary thrombolysis in the Grampian Region Early Anistreplase Trial (GREAT): Rawles J, on behalf of the GREAT Group J Am Coll Cardiol 23:1–5 Jan 1994

Halving of mortality at 1 year by domiciliary thrombolysis in the Grampian Region Early Anistreplase Trial (GREAT): Rawles J, on behalf of the GREAT Group J Am Coll Cardiol 23:1–5 Jan 1994

Having of mortality at 1 year by domiciliary thrombolysis in the grampian region early anistreplase trial (GREAT)

Objectives. Our aim was to determine the time saved by administration of thrombolytic therapy at home rather than in the hospital and to assess whether earlier thrombolysis resulted in decreased mortality from acate myocardial infarction.Background. There is much theoretic, experimental and trial evidence to indicate that in acute myocardial infarction the earlier that thrombolytic therapy is given, the greater its efficacy. However, the clinical importance of this time effect is uncertain.Methods. In a randomized double-blind parallel-group clinical trial, 311 patients with suspected acute myocrdial infarction seen by their general practitioners within 4 h of symptom onset were given intravenous anistreplase (30 U) either at home or later, after arrival in the hospital.Results. Anistreplase was given at home or in the hospital at median times of 101 and 240 min, respectively, after symptom onset. The median time saved by domiciliary thrombolysis was 130 min. By the end of 1 year after trial entry, 17 (10.4%) of 163 patients given anistreplase at home died compared with 32 (21.6%) of 148 in those allocated anistreplase in the hospital (relative reduction 52%, 95% confidence interval 14% to 89%, p = 0.007).Conclusions. In this trial the time saved by domiciliary thrombolysis by primary care physicians was >2 h. It is likely that a similar time saving would be achieved if prehospital thrombolysis were to become established practice. Prehospital thrombolysis resulted in a halving of the mortality rate from acute myocardial infarction.

Recovery of left ventricular function after acute myocardial infarction

The objective was to compare the effect of thrombolytic therapy given either at home or in hospital on the recovery of left ventricular function after acute myocardial infarction. In a randomized double-blind trial, 311 patients with suspected acute myocardial infarction were given 30 units anistreplase intravenously either at home, or later, in hospital. The median time-saving made with domiciliary thrombolysis was 130 min. All patients were admitted to hospital where left ventricular stroke distance was measured daily using a simple bedside ultrasound technique, and expressed as a percentage of the age-predicted normal value. The last recorded inpatient stroke distance measurement was used to assess residual left ventricular function after recovery from myocardial infarction. The mean stroke distance in patients with confirmed myocardial infarction was 74% on the day of admission, rising to 83% on the last inpatient day; it did not change between discharge and 3 months after admission. For 180 patients assigned randomly to treatment within 2 h of the onset of symptoms, mean stroke distance was greater by 6.8% in those given active anistreplase at home rather than in hospital (95% confidence interval 1.0 to 12.7%, P = 0.02), but there was no significant difference in stroke distance following home or hospital thrombolysis in 111 patients assigned treatment after that time (difference -2.0%, 95% confidence interval -8.4 to 4.5%, P = 0.54). The efficacy of thrombolytic therapy is enhanced when administered within 2 h of the onset of symptoms.

At-home thrombolysis reduced all-cause mortality and morbidity in patients with acute myocardial infarction

Source Citation GREAT Group. Feasibility, safety, and efficacy of domiciliary thrombolysis by general practitioners: Grampian region early anistreplase trial. BMJ. 1992 Sep 5;305:548-53.

Domiciliary thrombolysis by general practitioners.

Domiciliary thrombolysis by general practitioners.