title: Assessment of the practicality and safety of thrombolysis with anistreplase given by general practitioners.
abstract: BACKGROUND
  Recent guidelines recommend that patients with obvious acute myocardial infarction receive thrombolysis, unless contraindicated, within 60-90 minutes of summoning assistance. If this target is to be achieved, an increasing number of general practitioners are likely to be involved in the administration of thrombolytic agents.
  
  
  OBJECTIVE
  This study aimed to assess the practicality and safety of thrombolysis with anistreplase when given by general practitioners.
  
  
  METHODS
  An observational study was conducted in 805 general practices throughout the United Kingdom. Between March 1991 and September 1992, a total of 3383 patients with a clinical diagnosis of myocardial infarction were recruited--888 by 344 general practitioners who wished to include anistreplase in their management of myocardial infarction ('user' group) and 2495 by 776 general practitioners who did not wish to use anistreplase but who were willing to provide information about their cases ('comparison' group).
  
  
  RESULTS
  More than half the patients were seen within two hours of onset of symptoms. A high frequency of contra-indications to thrombolysis, diagnostic uncertainty, and other, mainly practical, reasons limited the number of occasions on which anistreplase was administered. Thus, only 310 patients were given anistreplase in the community. The general practitioners in the study used anistreplase safely. Their diagnostic accuracy was high (of the 310 patients given anistreplase 69% had a definite, possible or probably myocardial infarction, 4% a definite non-cardiac diagnosis), the number of patients given anistreplase in spite of a documented contraindication was small (seven patients), and the doctors appeared to be aware of potential bleeding problems associated with thrombolysis. In all cases, the complications of acute myocardial infarction appeared to be managed appropriately.
  
  
  CONCLUSIONS
  General practitioners can use anistreplase both appropriately and safely in the early management of acute myocardial infarction. Recognized contraindications to thrombolysis and practicalities of diagnosis and drug administration may, however, limit the number of occasions on which anistreplase is used.
authors.affiliation: Royal College of General Practitioners Manchester Research Unit.
authors.forename: P
authors.initials: P
authors.lastname: Hannaford
authors.forename: R
authors.initials: R
authors.lastname: Vincent
authors.forename: S
authors.initials: S
authors.lastname: Ferry
authors.forename: S
authors.initials: S
authors.lastname: Hirsch
authors.forename: C
authors.initials: C
authors.lastname: Kay
mesh_terms: D000328:Adult; D000368:Aged; D016255:Anistreplase / Q000009:adverse effects / Q000627:therapeutic use*; D000075202:Contraindications; D018849:Controlled Clinical Trials as Topic; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010819:Physician's Role; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors
chemical_list: D016255:Anistreplase