• S Hood, D Birnie, J L Curzio, and W S Hillis.
• Department of Medicine and Therapeutics, University of Glasgow, Gardiner Institute, Western Infirmary, Glasgow.
• Health Bull (Edinb). 1996 Mar 1; 54 (2): 131-9.

Objectives(a) To assess the practice of junior doctors who administer thrombolytic therapy in acute myocardial infarction. (b) To assess whether wider implementation of current guidelines is indicated.DesignPostal questionnaire survey. Each questionnaire was followed by a reminder.SettingTeaching and district general hospitals in Central and Southern Scotland.SubjectsTwo hundred and twelve junior doctors (excluding JHO's) regularly involved in the early assessment and management of patients with acute myocardial infarction.ResultsOne hundred and ten questionnaires were returned (response rate 52%). There was wide inter-individual variation in clinical practice regardless of whether subjects worked in teaching or district general hospitals or as cardiologists or non-cardiologists. As many as 12% of respondents administer thrombolytic therapy in the absence of ST elevation or bundle branch block on the presenting ECG. A high percentage of subjects considered diabetic retinopathy, but not a previous history of cerebrovascular disease, a contraindication to thrombolytic therapy. Only 29% and 32% respectively worked in institutions where formal policies existed for streptokinase readministration and rt-PA administration in preference to streptokinase. The administration of thrombolytic therapy in Accident and Emergency departments is not a popular strategy, and the full efficacy of rt-PA is not realised due to inappropriate use or failure to use intravenous heparin.ConclusionsThere is wide variation in clinical practice among junior doctors who administer thrombolytic therapy for acute myocardial infarction. Wider implementation and firmer current national guidelines would ensure that patients presenting with suspected acute myocardial infarction receive optimal therapy.

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