Maximising benefit from thrombolysis Results of a recent study [see Prescribing

section, this issue, p6] suggested that only 12-17% of patients presenting with acute myocardial infarction would currently receive thrombolytic therapy. 'The important question now before us is which patients with myocardial infarction are not being treated and why. The challenge for the future is to provide rapid therapy to patients who can benefit from it and delineate more clearly those in whom the therapy is ineffective or excessively hazardous. '

Working within currently accepted guidelines for use, late presentation and lack of physician experience emerge as major barriers to the use of thrombolytics. Late presentation can be combated by public education on the early symptoms of myocardial infarction and the paramount importance of early presentation. Also, admittance procedures for patients with chest pain should allow for rapid assessment and treatment of suitable candidates. Physicians in smaller hospitals who may lack experience with thrombolytics and may therefore be wary of using them should consider forming collectives to pool experience.

Further research should be directed at resolving issues relating to contraindications for thrombolytic therapy. The most appropriate regimen for patients with relative contraindications should be defined and patient selection criteria should be critically re­evaluated. For patients with unfavourable risk­benefit ratios with current thrombolytics, the development of new and specific thrombolytics may readdress the balance in their favour. Tate DA, Dehmer GJ. New challenges for thrombolytic therapy. Annals of Internal Medicine 110: 953-955, 15 Jun 1989 ".,

0156-270389/0715- 0003/0$01.00/0 © ADIS Press INPHARMA'" 15 Jul 1989 3