DELAY TO THROMBOLYSIS WITH RAPID BOLUS INJECTION COMPARED
TO INFUSION. V. Wade*, and P. Kelleher. Bankstown-Lidcombe Hospital, Sydney, NSW. Reduced delay to thrombolysis improves outcome for acute
myocardial infarction (AMI). New bolus
thrombolytic agents may be easier to administer by nursing staff taking less
time to prepare and may result in reduced delay. This study compares delay to thrombolysis from emergency unit
[EU] triage to start of drug in coronary care [CCU] with three different
agents, streptokinase [STK], alteplase [TPA] and reteplase [RPA]. Time to thrombolysis was collected
prospectively from 27/8/97 to 10/11/99.
TPA and STK were given during 1997 and 1998 with RPA and STK in
1999. Our hospital protocol was for TPA
or RPA to be given for anterior AMIs less than 4 hours from symptom onset,
other AMIs received STK. There were 170
subjects given thrombolysis in the study with a mean age of 61.8 years, range
30-87 years, there were 127 males and 43 females. Median time delays in minutes are shown and times for drugs were
compared with t test. STK
Infusion TPA
Infusion RPA
Bolus N
of subjects 83 59 28 Median
time 52
mins 50
mins 35.5
mins Time
range 15-350
mins 15-180
mins 10-144
mins RPA
vs TPA RPA
vs STK TPA
vs STK t
test p
= .035 p
= .001 p
= .06 Conclusion:
significantly reduced delay to thrombolysis was found with bolus RPA
compared to infusion of TPA or STK suggesting time involved in setting up
infusions may be a significant factor in delay and indicating advantage for bolus
agents.
