Skip to main content
Log in

Criteria for Drug Usage Review of Thrombolytics in Acute Myocardial Infarction

  • Review Article
  • Drug Usage Review af Thrombolytics
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Summary

Thrombolytic drugs are now the mainstay of the management of acute myocardial infarction (AMI). Although their use is associated with reduced mortality, significant adverse effects can occur, especially if they are used inappropriately. Drug usage review of this group of drugs provides a measure of the appropriateness of their use. The development of criteria against which the use of these drugs can be compared allows the collection of qualitative and quantitative data on their use. Those criteria identified during this process include: evidence for, and accuracy of, diagnosis of AMI; when, where and how to administer the drug; what drug to use, and at what dose. Identification of potential adverse effects, measures of treatment success and the role of adjunctive therapy may also be included as part of a drug usage evaluation process.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Tiefenbrunn Al, Sobel BE. The impact of coronary thrombolysis on myocardial infarction. Fibrinolysis 1989; 3: 1–15

    Google Scholar 

  2. GISSI (Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto Miocardico). Effectiveness of intravenous thrombolytictreatment in acute myocardial infarction. Lancet 1986; l: 397–401

    Google Scholar 

  3. ISIS–2 Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187cases of acute myocardial infarction: ISIS–2. Lancet 1988; 2: 349–59

    PubMed  Google Scholar 

  4. Wilcox RG, Olsson CG, Skene AM, et al. Trial of tissue plasminogen activator for mortality reduction in acute myocardialinfarction. Lancet 1988; 2: 525–30

    Article  PubMed  CAS  Google Scholar 

  5. AIMS Trial Study Group. Effect of intravenous APSAC on mortality after acute myocardial infarction: preliminary reportof a placebo—controlled clinical trial. Lancet 1988; l: 545–9

    Google Scholar 

  6. Weston CFM, Penny Wl, lulian DG. Guidelines for the early management of patients with myocardial infarction. BMl 1994; 308: 767–71

    Article  CAS  Google Scholar 

  7. Stolar MH. Drug use review: operational definitions. Am J Hosp Pharm 1978; 35: 76–8

    PubMed  CAS  Google Scholar 

  8. Mehl B. Evolving concepts in hospital pharmacy management: drug usage evaluation. l st ed. New Jersey: Scientific TherapeuticsInformation Inc., 1990

  9. Adams J, Trent R, Rawles J. Earliest electrocardiographic evidence of myocardial infarction: implications for thrombolytictherapy. BMJ 1993; 307: 409–13

    Article  PubMed  CAS  Google Scholar 

  10. Collins DR, Wright DJ, Rinsler MG, et al. Early diagnosis of myocardial infarction with use of a rapid immunochemicalassay of creatine kinase—MB isoenzyme. Clin Chem 1993; 39: 1725–8

    PubMed  CAS  Google Scholar 

  11. Lee HS, Cross SJ, Garthwaite P, et al. Comparison of the value of novel rapid measurement of myoglobin, creatine kinase,and creatine kinase—MB with the electrocardiogram for thediagnosis of acute myocardial infarction. Br Heart J 1994; 71: 311–5

    Article  PubMed  CAS  Google Scholar 

  12. Timmis AD. Will serum enzymes and other proteins find a clinical application in the early diagnosis of myocardial infarction? Br Heart J 1994; 71: 309–10

    Article  PubMed  CAS  Google Scholar 

  13. Chapman GD, Ohman EM, Topol EJ, et al. Minimising the risk of inappropriately administered thrombolytic therapy. Am J Cardiol 1993; 71: 783–7

    Article  PubMed  CAS  Google Scholar 

  14. The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardialinfarction. N Engl J Med 1993; 329: 673–82

    Article  PubMed  Google Scholar 

  15. Fibrinolytic Therapy Trialist (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected myocardial infarction:collaborative overview of early mortality and majormorbidity results from alI randomised trials of more than 1000patients. Lancet 1994; 343: 311–21

    PubMed  Google Scholar 

  16. Late Study Group. Late assessment of thrombolytic efficacy (LATE) study with alteplase 6–24 hours after onset of acutemyocardial infarction. Lancet 1992; 342: 759–66

    Article  Google Scholar 

  17. EMARAS Collaborative Group. Randomised trial of late thrombolysis in patients with suspected acute myocardial infarction. Lancet 1993; 342: 767–72

    Article  PubMed  Google Scholar 

  18. Gray D, Keating NA, Murdock J, et al. Impact of hospital thrombolysis policy on out—of—hospital response to suspectedmyocardial infarction. Lancet 1993; 341: 654–7

    Article  PubMed  CAS  Google Scholar 

  19. GREAT Group. Feasibility, safety, and efficacy of domiciliary thrombolysis by generaI practitioners: Grampian region earlyanistreplase trial. BMJ 1992; 305: 548–53

    Article  PubMed  Google Scholar 

  20. Rawles J. Halving of mortality at l year by domiciliary thrombolysis in the Grampian region early anistreplase trial(GREAT). J Am Coll Cardiol 1994; 23: 1–5

    Article  PubMed  CAS  Google Scholar 

  21. Wilcox RG. Thrombolysis and the generaI practitioner (2). BMJ 1990; 300: 869–70

    Article  PubMed  CAS  Google Scholar 

  22. The Thrombolysis Early in Acute Heart Attack Trial Study Group. Very early thrombolytic therapy in suspected acutemyocardial infarction. Am J Cardiol 1990; 65: 401–7

    Article  PubMed  Google Scholar 

  23. Linderer T, Schroder R, Arntz R, et al. Pre—hospital thrombolysis: beneficiaI effects of very early treatment on infarct sizeand left ventricular function. J Am Coll Cardiol 1993; 22: 1304–10

    Article  PubMed  CAS  Google Scholar 

  24. Weaver WD, Cerqueira M, Hallstrom AP, et al. Prehospital—initiated vs hospital—initiated thrombolytic therapy. JAMA 1993; 270: 1211–6

    Article  PubMed  CAS  Google Scholar 

  25. Rule S, Brooksby P, Sanderson J. Use ofthrombolysis for acute myocardial infarction by general practitioners. Postgrad Med J 1993; 69: 190–3

    Article  PubMed  CAS  Google Scholar 

  26. Pell ACH, Miller HC, Robertson CE, et al. Effect of ‘fast track’ admission for acute myocardial infarction on delay to thrombolysis. BMJ 1992; 304: 83–7

    Article  PubMed  CAS  Google Scholar 

  27. Clarke KW, Gray D, Keating NA, et al. Do women with acute myocardial infarction receive the same treatment as men? BMJ 1994; 309: 563–6

    Article  PubMed  CAS  Google Scholar 

  28. lackson G. Coronary artery disease and women. BMJ 1994; 309: 555–7

    Article  PubMed  CAS  Google Scholar 

  29. Sleight P. Is there an age limit for thrombolytic therapy. Am J Cardiol 1993; 72 Suppl 6: 306–36

    Google Scholar 

  30. Langland-Orban B, Orban DV. The choice of thrombolytic agents in the emergency department. Ann Emerg Med 1993; 22: 845–51

    Article  PubMed  CAS  Google Scholar 

  31. Cheseboro JH, Knatterud G, Roberts R, et al. Thrombolysis in myocardial infarction (TIMI) trial. Phase I: a comparison betweenintravenous tissue plasminogen activator and intravenousstreptokinase. Circulation 1987; 76: 142–54

    Article  Google Scholar 

  32. ISIS–3 (Third International Study of Infarct Survival) Collaborative Group. ISIS–3: a randomised trial of streptokinase vstissue plasminogen activator vs anistreplase and of aspirinplus heparin vs aspirin alone among 41 299 cases of suspectedacute myocardial infarction. Lancet 1992; 339: 753–70

    Article  PubMed  Google Scholar 

  33. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Myocardico. GISSI–2: a factorial randomised trial of alteplaseversus streptokinase and heparin versus no heparin among 12490 patients with acute myocardial infarction. Lancet 1990; 336: 65–71

    PubMed  Google Scholar 

  34. The International Study Group. In—hospital mortality and clinical course of 20 891 patients with suspected acute myocardialinfarction randomised between alteplase and streptokinasewith and without heparin. Lancet 1990; 336: 71–5

    Article  PubMed  Google Scholar 

  35. Carney RJ, Murphy GA, Brandt TR, et al. Randomised angiographic trial of recombinant tissue—type plasminogen activator(alteplase) in myocardial infarction: RAAMI studyinvestigators. J Am Coll Cardiol 1992; 20: 17–23

    Article  PubMed  CAS  Google Scholar 

  36. Taylor GJ, Moses HW, Koester D, et al. A difference between front—Ioaded streptokinase and standard—dose recombinanttissue—type plasminogen activator in preserving left ventricularfunction after acute myocardial infarction (the CentraI IllinoisThrombolytic Therapy study). Am J Cardiol 1993; 72: 1010–4

    Article  PubMed  CAS  Google Scholar 

  37. Purvis JA, Mcneill AJ, Siddiqui RA, et al. Efficacy of 100mg of double—bolus alteplase in achieving complete perfusion inthe treatment of acute myocardial infarction. J Am Coll Cardiol 1994; 23: 6–10

    Article  PubMed  CAS  Google Scholar 

  38. Simoons ML, Arnout J, van der Brandt M, et al. Retreatment with alteplase for early signs of reocclusion after thrombolysis. Am J Cardiol 1993; 71: 524–8

    Article  PubMed  CAS  Google Scholar 

  39. Anderson JL, Karagounis L, Allen A, et al. Older age and elevated blood pressure are risk factors for intracerebral hemorrhageafter thrombolysis. Am J Cardiol 1991; 68: 166–70

    Article  PubMed  CAS  Google Scholar 

  40. De laegere PP, Arnold AA, Balk AH, et al. Intracranial hemorrhage in association with thrombolytic therapy: incidenceand clinical predictive factors. J Am Coll Cardiol 1992; 19: 289–94

    Article  PubMed  Google Scholar 

  41. Herlitz J, Hartford M, Aune S, et al. Occurrence of hypotension during streptokinase infusion in suspected acute myocardialinfarction, and its relation to prognosis and metoprol01 therapy. Am J Cardiol 1993; 71: 1021–4

    Article  PubMed  CAS  Google Scholar 

  42. Walker G. ABPI Data Sheet Compendium 1994–95. London: Datapharm Publications Ltd., 1994: 647–8

  43. Walker G. ABPI Data Sheet Compendium 1994–95. London: Datapharm Publications Ltd., 1994: 1178–9

  44. Walker G. ABPI Data Sheet Compendium 1994–95. London: Datapharm Publications Ltd., 1994: 181–2

  45. Walker G. ABPI Data Sheet Compendium 1994–95. London: Datapharm Publications Ltd., 1994: 248–9

  46. The ISAM Study Group. A prospective triai of streptokinase in acute myocardiai infarction (ISAM). N Engi J Med 1986; 314: 1465–71

    Article  Google Scholar 

  47. Santarelli P, Lanza GA, Biscione F, et al. Effects of thromboIysis and atenoioi or metoproioi on the signal—averaged electrocardiogramafter acute myocardiai infarction. Am J Cardiol 1993; 71: 525–31

    Article  Google Scholar 

  48. Tobé TJM, de Langen COJ, Crijns HJGM, et al. Effects of streptokinase during acute myocardiai infarction on the signaiaveraged electrocardiogram and on the frequency of late arrhythmias. Am J Cardiol 1993; 72: 647–51

    Article  PubMed  Google Scholar 

  49. Pedretti RFE, Colombo E, Braga SS, et al. Effect of thromboIysis on heart rate variability and Iife–threatening ventriculararrhythmias in survivors of acute myocardiai infarction. J AmColl Cardiol 1994; 23: 19–26

    Article  PubMed  CAS  Google Scholar 

  50. Lanter PL, Foster Jennings C, Roberts CS, et al. Safety of thrombolytic therapy in normally menstruating women withacute myocardiai infarction. Am J Cardiol 1994; 74: 179–81

    Article  PubMed  CAS  Google Scholar 

  51. Buchalter MB, Suntharalingam G, Jennings I, et al. Streptokinase resistance: when might streptokinase administration beineffective? Br Heart J 1992; 68: 449–53

    Article  PubMed  CAS  Google Scholar 

  52. Lee HS, Cross S, Oavidson R, et al. Raised Ievei of antistreptokinase antibody and neutralisation titres from 4 daysto 54 months after administration of streptokinase or anistreplase. Eur Heart J 1993; 14: 84–9

    Article  PubMed  CAS  Google Scholar 

  53. Jalihai S, Morris GK. Antistreptokinase titres after intravenous streptokinase. Lancet 1990; 335: 184–5

    Article  Google Scholar 

  54. Patei S, Jalihai S, Outka OP, et al. Streptokinase neutralisation titres up to 866 days after intravenous streptokinase for acutemyocardiai infarction. Br Heart J 1993; 70: 119–21

    Article  Google Scholar 

  55. Green C. Antistreptokinase titres after topicai streptokinase [letter]. Lancet 1993; 341: 1602–3

    Article  PubMed  CAS  Google Scholar 

  56. Buchalter MB. Are streptokinase antibodies clinically important? Br Heart J 1993; 70: 101–2

    Article  PubMed  CAS  Google Scholar 

  57. Shaigla G, Chandrashekhar YS, Kumar N, et al. Antistreptokinase antibodies before and after streptokinase therapy inpatients with acute myocardiai infarction from areas endemicfor streptococcai infection and influence on reperfusion rates. Am J Cardiol 1994; 74: 187–9

    Article  Google Scholar 

  58. Gemmill JO, Hogg KJ, Ounn FG, et al. Pre—dosing antibody Ieveis and efficacy of thrombolytic drugs containing streptokinase. Br Heart J 1994; 72: 222–5

    Article  PubMed  CAS  Google Scholar 

  59. Vogt A, von Essen R, Tebbe U, et al. Impact of early perfusion status ofthe infarct—related artery on short term mortality afterthrombolysis for acute myocardiai infarction: retrospectiveanalysis of four German multicentre studies. J Am Coll Cardiol 1993; 21: 1391–5

    Article  PubMed  CAS  Google Scholar 

  60. Anderson JL, Karagounis LA, Becker LC, et al. TIMI perfusion grade 3 but not grade 2 results in improved outcome afterthrombolysis for myocardiai infarction: ventriculographic,enzymatic and electrocardiographic evidence from theTEAM–3 study. Circulation 1993; 87: 1829–39

    Article  PubMed  CAS  Google Scholar 

  61. Vogt A, Tebbe U, von Essen R, et al. Go–minute patency and optima1 perfusion of infarct related coronary arteries [abstract]. Circulation 1992; 86 Suppl.: 1–268

    Google Scholar 

  62. Lincoff AM, Topoi EJ. Trickle down thrombolysis. J Am Coll Cardiol 1993; 21: 1396–8

    Article  PubMed  CAS  Google Scholar 

  63. Nicolau JC, Lorga AM, Garzon SAC, et al. Ciinicai and Iaboratory signs of reperfusion: are they reliable? Int J Cardiol 1989; 25: 313–20

    Article  PubMed  CAS  Google Scholar 

  64. Christian TF, Gibbons RJ, Hopfenspirger MR, et al. Severity and response of chest pain during thrombolytic therapy foracute myocardiai infarction: a usefui indicator of myocardiaisalvage and infarct size. J Am Coll Cardioi 1993; 22: 1311–6

    Article  CAS  Google Scholar 

  65. Oison HG. Bedside cardiology and thrombolysis. J Am Coll Cardiol 1993; 22: 1317–9

    Article  Google Scholar 

  66. Berger PB, Ruocco NA, Ryan TG, et al. Incidence and significance of ventricular tachycardia and fibrillation in the absenceof hypotension or heart failure in acute myocardiaiinfarction treated with recombinant tissue—type plasminogenactivator: results from the Thrombolysis in Myocardiai Infarction(TIMI) Phase II trial. J Am Coll Cardiol 1993; 22: 1773–9

    Article  PubMed  CAS  Google Scholar 

  67. Shah PK, Cercek B, Lew AS, et al. Angiographic validation of bedside markers of reperfusion. J Am Coll Cardiol 1993; 21: 55–61

    Article  PubMed  CAS  Google Scholar 

  68. Gibbon MC, Cannon CP, Plana RN, et al. Consequences of TIMI grade 2 vs 3 flow at 90 minutes following thrombolysis [abstract] J Am Coll Cardiol 1993; 21 Suppl. A: 348

    Google Scholar 

  69. Shah PK, Ganz W. Bedside markers of coronary reperfusion [reply]. J Am Coll Cardiol 1993; 22: 2058–9

    Article  Google Scholar 

  70. Shechter M, Rabinowitz B, Beker B, et al. Additionai ST segment elevation during the first hour of thrombolytic therapy:an electrocardiographic sign predicting a favourable clinicaioutcome. J Am Coll Cardiol 1992; 20: 1460–4

    Article  PubMed  CAS  Google Scholar 

  71. Kondo M, Tamura K, Tanio H, et al. Is ST–segment re–elevation associated with reperfusion an indicator of marked myocardiaidamage after thrombolysis? J Am Coll Cardiol 1993; 21: 62–7

    Article  PubMed  CAS  Google Scholar 

  72. Langer A, Minkowitz J, Oorian P, et al. Pathophysiology and prognostic significance of Holter–detected ST segment depressionafter myocardiai infarction. The Tissue PlasminogenActivator: Toronto (TPAT) Study Group. J Am Coll Cardiol 1992; 20: 1313–7

    Article  PubMed  CAS  Google Scholar 

  73. Ong L, Reiser P, Coromilis J, et al. Left ventricular function and rapid release of creatine kinase MB in acute myocardiai infarction. N Engi J Med 1983; 309: 1–6

    Article  CAS  Google Scholar 

  74. Olson HG, Butman SM, Piters KM, et al. A randomized controlled triai of intravenous streptokinase in evolving myocardiaiinfarction. Am Heart J 1986; 111: 1021–9

    Article  PubMed  CAS  Google Scholar 

  75. Remppis A, Scheffold T, Karrer O, et al. Assessment ofreperfusion of the infarct zone after acute myocardiai infarction byseriai cardiac troponin T measurements in serum. Br Heart J 1994; 71: 242–8

    Article  PubMed  CAS  Google Scholar 

  76. Hsia J, Hamilton WP, Kleiman N, et al. A comparison between heparin and Iow dose aspirin as adjunctive therapy with tissueplasminogen activator for acute myocardia1 infarction. N Engi J Med 1990; 323: 1433–7

    Article  CAS  Google Scholar 

  77. Bleich SO, Nicho1s TC, Schumacher RR, et al. Effect of heparin on coronary artery patency after thrombolysis with tissueplasminogen activator in acute myocardiai infarction. Am J Cardiol1990; 66: 1412–7

  78. Ridker PM, Hebert PR, Fuster V, et al. Are both heparin and aspirin justified as adjuncts to thrombo1ytic therapy for acutemyocardiai infarction? Lancet 1993; 341: 1574–7

    Article  PubMed  CAS  Google Scholar 

  79. ISIS–1 (First Internationai Study of Infarct Survival) Collaborative Group. Randomized triai of intravenous atenoioiamong 16,027 cases of suspected acute myocardiai infarction. Lancet 1986; 2: 57–66

    Article  PubMed  Google Scholar 

  80. Roberts R, Rogers WJ, Mueller HS, et al. Immediate versus deferred beta—blockade following thrombolytic therapy inpatients with acute myocardiai infarction: results of thethrombolysis in myocardiai infarction (TIMI) II—B study. Circulation 1991; 83: 422–37

    Article  PubMed  CAS  Google Scholar 

  81. Woods KL, Fletcher S, Roffe C, et al. Intravenous magnesium sulphate in suspected acute myocardiai infarction: results ofthe second Leicester intravenous magnesium interventiontriai (LIMIT–2). Lancet 1992; 339: 1553–8

    Article  PubMed  CAS  Google Scholar 

  82. Woods KL, Fletcher S. Long term outcome after intravenous magnesium sulphate in suspected acute myocardial infarction:the second Leicester intravenous magnesium interventiontrial (LIMIT–2). Lancet 1994; 343: 816–9

    Article  PubMed  CAS  Google Scholar 

  83. Horner SM. Efficiency 01’ intravenous magnesium in acute myocardial infarction in reducing arrhythmias and mortality. Circulation 1992; 86: 774–9

    Article  PubMed  CAS  Google Scholar 

  84. ISIS Collaborative Group. ISIS–4: randomised study ofintravenous magnesium in over 50 000 patients with suspected acutemyocardial infarction [abstract]. Circulation 1993; 88 Suppl.: 1–292

    Google Scholar 

  85. Casscells W. Magnesium and myocardial infarction. Lancet 1994; 343: 807–9

    Article  PubMed  CAS  Google Scholar 

  86. Simoons ML, Arnold AE. Tailored thrombolytic therapy: a perspective. Circulation 1993; 88: 2556–64

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

McGlynn, S. Criteria for Drug Usage Review of Thrombolytics in Acute Myocardial Infarction. Pharmacoeconomics 7, 25–38 (1995). https://doi.org/10.2165/00019053-199507010-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00019053-199507010-00004

Keywords

Navigation