Feasibility, safety, and efficacy of domiciliary thrombolysis by general practitioners: Grampian region early anistreplase trial. GREAT Group.
OBJECTIVE
To assess the feasibility, safety, and efficacy of domiciliary thrombolysis by general practitioners.


METHODS
Randomised double blind parallel group trial of anistreplase 30 units intravenously and placebo given either at home or in hospital.


METHODS
29 rural practices in Grampian admitting patients to teaching hospitals in Aberdeen (average distance 36 (range 16-62) miles).


METHODS
311 patients with suspected acute myocardial infarction and no contraindications to thrombolytic therapy seen at home within four hours of onset of symptoms.


METHODS
Time saving, adverse events, Q wave infarction, left ventricular function.


RESULTS
Anistreplase was administered at home 101 minutes after onset of symptoms, while anistreplase was given in hospital 240 minutes after onset of symptoms (median times). Adverse events after thrombolysis were infrequent and, apart from cardiac arrest, not a serious problem when they occurred in the community: seven of 13 patients were resuscitated after cardiac arrest out of hospital. By three months after trial entry the relative reduction of deaths from all causes in patients given thrombolytic therapy at home was 49% (13/163 (8.0%) v 23/148 (15.5%); difference -7.6% (95% confidence interval -14.7% to -0.4%), p = 0.04). Full thickness Q wave infarction was less common in patients with confirmed infarction receiving treatment at home (65/122 (53.3%) v 76/112 (67.9%); difference -14.6% (95% confidence interval -27.0% to -2.2%), p = 0.02).


CONCLUSIONS
General practitioners provided rapid pre-hospital coronary care of a high standard. Compared with later administration in hospital, giving anistreplase at home resulted in reduction in mortality, fewer cardiac arrests, fewer Q wave infarcts, and better left ventricular function. Benefits were most marked where thrombolytic therapy was administered within two hours of the onset of symptoms.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016255:Anistreplase / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004632:Emergency Medical Services / Q000592:standards; D005194:Family Practice; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D012449:Safety; D012606:Scotland; D015912:Thrombolytic Therapy / Q000592:standards*; D016896:Treatment Outcome
D016255:Anistreplase