Prof Alberti doesn't share your anxieties Rowley as I found browsing his
report on emergency access at the address below.
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Rowley Cottingham
Sent: 05 December 2006 12:11
To: [log in to unmask]
Subject: Re: Thrombolysis for PEs
I looked at this a year or two back. The 'official' guidelines for PE
are based on a guess made in a Spanish paper for the doses required for
alteplase. Essentially, they looked at the then recommended dose for MI
(If I remember correctly it was around 1991) and used the same dose. MI
dosing has moved on, that for PEs hasn't. The data is really not
terribly impressive (I was about to write robust, but as it is the
current buzzsynonym for everything from 'worth doing' to
Trust-enforcing-insistence I have banned it from my personal lexicon)
and could easily be looked at again. There's a nice piece of work there
we could do as a multiple site group.
I'm very opposed to thrombolysis for stroke - it is really too crude a
> *From:* "McCormick Simon Dr, Consultant, A&E"
> <[log in to unmask]>
> *To:* [log in to unmask]
> *Date:* Tue, 5 Dec 2006 08:49:56 -0000
> I suppose that's part of the point I'm trying to make. Alteplase has
> the licence for PE thrombolysis and its unlikely any other company is
> going to do the trials necessary to get one so using another
> fibrinolytic is technically prescribing off licence. Locally we'd
> rather use a drug everyone is familiar with and we use Reteplase for
> so it makes sense to stick with that. However, this flies in the face
> of the BTS guidelines and the licensing so we need to make sure we are
> not going out on a limb. The consultants are generally happy with the
> idea but it's the Risk Managers that get twitchy.
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