Acute Myocardial Infarction

Appropriateness, Time to Treatment, and Medication Errors with Reteplase and Alteplase for Acute Myocardial Infarction

Objectives

In the medical management of acute myocardial infarction (AMI), delays in door-to-needle time and medication errors during thrombolytic administration can have a negative impact on patient outcome. The aim of this study is to evaluate and compare the use of alteplase and reteplase for AMI at Lion’s Gate Hospital (LGH) with respect to appropriateness of choice of therapy over streptokinase, door-to-needle time, medication errors, and efficacy and toxicity.

Setting

A Canadian community hospital.

Design

A retropective chart review of patients admitted to LGH emergency department from August 1, 2000 to April 30, 2002 with a primary diagnosis of AMI was performed.

Results

A total of 52 patients receiving either alteplase (n=30) or reteplase (n=22) were included in the study. The choice of either fibrinolytic agent studied instead of streptokinase was inappropriate in 17 (33%) of the cases reviewed. Median door-to-needle times were 20 minutes with reteplase and 30 minutes with alteplase; 82% of reteplase patients and 53% of alteplase patients were treated within the 30 minute target. This was driven mostly by a shorter data-to-drug time. There appeared to be a fewer number of medication time errors with reteplase than with alteplase (9% vs. 27%), as well as a smaller mean magnitude of time errors (25% vs. 33%).

Conclusions

Use of reteplase in AMI at LGH appears to be associated with a shorter median door-to-needle time and less potential for medication errors compared to alteplase. Cost savings may be realized with the appropriate therapeutic choice of reteplase or alteplase over streptokinase in the medical management of AMI.

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