TPA and streptokinase are each much more effective if begun quickly after
symptoms appear. For example, streptokinase infused/injected within an hour
of a heart attack was shown in one study to reduce deaths 47 percent -- a
reduction that declined to 26 percent if administered in the first three
hours and further declined to 17 percent if administered in three to six
The constraints here are:
Some staff have concerns about their ability to interpret ECGs with
sufficient confidence to initiate therapy and may need training to increase
their confidence to levels where they will be happy.
Experience with thrombolytic agents has raised concerns amongst some
clinicians about reactions - haemorrhagic, anaphylactic or arrhythmic.
However with the development of newer agents, it has become clear that most
of these concerns are unfounded. Training and education will need to address
this issue if wider use is to be achieved.
For agents that need complicated infusion or injection schedules, infusion
pumps are required. A number of scenarios may exist which is dependant on
the patients condition. A syringe driver may be required if fast acting
drugs are being used at low rates [i.e. less than 5ml/hr] the reason for this is that
syringe drivers are more accurate and deliver fast acting drugs smoothy due
to their linear operation. Some infusion pumps are very accurate over an hour, but over a few minutes at low rates the fluctuation in delivery (due to the pumping mechanism) can change by as much as 80%. At higher infusion rates with larger volumes it
may be neccessary to use infusion pumps. Dependant upon the skill of the
clinical user, the infusion pump may also be used in taper mode to deliver
at different rates automatically.
Thrombosis can also be treated with the use of DVT compression systems and
anti embolism stockings