Brits approve thrombolytic therapy for heart attack

British physicians are finally making official the theory that lives can be saved by administering thrombolytic drugs to acute myocardial infarction (AMI) patients before sending them to the hospital. A guideline issued by the British Heart Foundation in London recommends that AMI patients receive thrombolytics within 90 minutes of calling for help.1

Researchers tracked time between a call for help and the delivery of thrombolytic drugs in 1,000 Scottish patients with suspected AMI, of whom half lived in rural communities and half in urban or suburban areas. A third of patients living in rural areas were given thrombolytic drugs by their physician within 45 minutes of calling. The rest incurred a 150-minute delay when they were taken to the hospital before the initiation of thrombolytics. All urban and suburban patients were taken to the hospital, and the call to thrombolysis time was about 100 minutes. Within this group, the interval time was shortened by 38 minutes when patients were taken directly to a coronary care unit instead of to the emergency department.

The researchers said the failure of urban and suburban physicians to administer thrombolytic drugs faster was due to habit. "The delay is inordinate," they said. They advise that thrombolytic treatment be given, if practical, before the patient is transported, and by the first qualified person to see the patient.


1. Rawles J, Sinclair C, Jennings K, et al. Call to needle times after acute myocardial infarction in urban and rural areas in northeast Scotland: A prospective observational study. British Medical Journal 1998; 317:576-578.