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Thrombolytics for Acute Myocardial Infarction in a Prehospital Setting: A Review of Comparative Safety, and Guidelines

Last updated: July 9, 2019
Project Number: RC1144-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the comparative safety of thrombolytic administration performed in a prehospital versus hospital setting for treatment of acute myocardial infarction?
  2. What is the comparative safety of thrombolytic administration performed in a prehospital setting compared with no or significantly delayed thrombolytic administration for the treatment of acute myocardial infarction?
  3. What are the evidence-based guidelines regarding thrombolytic administration for the treatment of acute myocardial infarction in prehospital settings?

Key Message

One relevant systematic review was identified regarding the safety of thrombolytic administration performed in a prehospital setting versus hospital setting for the treatment acute myocardial infarction. The systematic review included one relevant primary study, which revealed uncertainty in the safety findings between prehospital and hospital administration of thrombolytics. No evidence was found regarding the comparative safety of thrombolytic administration performed in a prehospital setting compared with no or significantly delayed thrombolytic administration for the treatment of acute myocardial infarction.Five evidence-based guidelines were identified regarding thrombolytic administration for the treatment of acute myocardial infarction in prehospital settings. Overall, the guidelines were of acceptable quality and recommendations were based on varying quality of evidence. Three guidelines provided optimal timing recommendations for the administration of thrombolytics. The recommendations also varied as a function of the proximity of the patient to a percutaneous coronary intervention capable hospital. Two other guidelines recommended prehospital administration of thrombolytics, under specific protocols and dependent on expected transportation time. One guideline did not recommend the use of thrombolytics in patients with non-ST-elevation acute coronary syndrome.The limitations of the included study and guidelines, such as gender equity in the applicability of the evidence (i.e. unclear whether gender differences were considered), incomplete outcome reporting, or lack of studies from Canadian settings, should be considered when interpreting the results.