Should GPs administer thrombolytics? Since the results of large studies have indicated that earlier treatment with thrombolytics confers greater benefit in acute myocardial infarction than later administration, prehospital initiation of thrombolytic treatment for acute coronary occlusion is potentially ideal. However, since normal ECGs may be seen in the

early stage of suspected myocardial infarction and are associated with low risk of mortality. the risk of major adverse events, including ventricular fibrillation, from thrombolytic therapy would seem an unnecessary threat to these patients. Furthermore. studies have shown that patients receive thrombolytic treatment faster via direct hospital admission or emergency ambulance service than by GP referral. Even so, 'in isolated

or rural communities family practitioners may need to take responsibility for thrombolysis and give the treatment in community hospitals'. These general

practitioners would need to be thoroughly trained and prepared to deal with potentially lifethreatening complications. For the urban patient, simultaneous attention by the general practitioner and ambulance service would allow earlier administration of appropriate opiate analgesia and guidance of thrombolytic therapy.

'Domiciliary administration of thrombolytic agents by the family practitioner may be practicable, however, only if he or she is prepared, trained and equipped to provide an individualised intensive care service within a patient's home.'

Fox KAA. Thrombolysis and Ihe general pract itio ner. Brilish Medical ·-u Journal 300: 867-868. 31 Mar 1990

14 Ap, 1990

INPHARMA~

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