> Actually the NSF thrombolysis targets apply only to
> "barn-door" obvious
> cases. If the case is dubious, the deadlines, thankfully, no
> longer apply!
Yes, but there will always be cases where the risk/ benefit analysis could
fall the other way. Jonathan Benger has posted a useful posting with
considerably more consideration of the facts than my own. To carry on from
that, would you thrombolyse an 80 year old (if you consider the subgroup
analysis that showed no benefit of thrombolysis in the over 75s) on warfarin
with an inferior MI? Aim for a 20 minute time and I don't think you'll have
adequate consideration of the facts and the risk/ benefit analysis (indeed
it's likely that a lot of places will go for a thrombolysis nurse who'll
work strictly to protocols).
> I think there is a separate debate about whether we would
> prefer more resources put into cath labs with 24 hours
> primary PTCA capability rather than into pre-hosp
> thrombolysis or reducing Door to Needle times. And if we go
> down the primary PTCA route, whether we should be
> administering a single dose of eg. Reteplase pre-PTCA
> together with Gp2b/3a.
Agree we need to discuss this in the long term. But very long term- we have
nothing like the numbers of interventional cardiologists we need for this so
would need to expand consultants greatly (although I seem to recall that
when primary PTCA was discussed here a few years back someone suggested that
A and E consultants should be trained to do it). We have a cardiologist here
who did a lot of training in Holland. There, a population of 100,000 is
considered sufficient to support a catheter suite. In terms of
interventional cardiology we lag way behind a lot of other countries.
However, primary PTCA as a routine procedure would need major changes to the
health service for limited benefit in my opinion. We should keep the
discussion open though.
Matt Dunn
Warwick
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