Guidance on the Use of Drugs for Early Thrombolysis in the Treatment of Acute Myocardial Infarction (TA52)

Technology Appraisal Guidance No. 52

Source: National Institute for Health and Care Excellence

This guidance provides recommendations on the selection of thrombolytic drugs in patients with acute myocardial infarction (AMI). Recommendations are made in relation to the use of the drugs in hospital and pre-hospital settings. The guidance does not compare hospital and pre-hospital models of delivering thrombolysis.

  • It is recommended that, in hospital, the choice of thrombolytic drug (alteplase, reteplase, streptokinase or tenecteplase) should take account of:

    - the likely balance of benefit and harm (for example, stroke) to which each of the thrombolytic agents would expose the individual patient

    - current UK clinical practice, in which it is accepted that patients who have previously received streptokinase should not be treated with it again

    - the hospital's arrangements for reducing delays in the administration of thrombolysis.

  • Where pre-hospital delivery of thrombolytic drugs is considered a beneficial approach as part of an emergency-care pathway for AMI (for example, because of population geography or the accessibility of acute hospital facilities), the practicalities of administering thrombolytic drugs in pre-hospital settings mean that the bolus drugs (reteplase or tenecteplase) are recommended as the preferred option.

The guidance shown above constitutes Section 1 of the full document. A copy of the full document and a summary of the evidence is available on the Internet at

Copies of the document can also be obtained by contacting 0845 003 7783 or emailing and quoting reference number N0157.

This guidance represents the view of the Institute which was arrived at after careful consideration of the available evidence. Health professionals are expected to fully take it into account when exercising their clinical judgement. This guidance does not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

© Copyright National Institute for Health and Care Excellence. All rights reserved. This material may be freely reproduced for educational and not for profit purposes within the NHS. No reproduction by or for commercial organisations is permitted without the express written permission of the Institute.

Enquiries concerning the guidance should be addressed to: National Institute for Health and Care Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA. email:

Guidance on the Use of Drugs for Early Thrombolysis in the Treatment of Acute Myocardial Infarction.
Issue Date: October 2002
Review Date: October 2005

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