Clinician Adherence to Evidence Based Use of Anti-platelet Therapy at the Time of Thrombolysis for ST-elevation Myocardial Infarction

Abstract

AIM: The use of dual anti-platelet therapy prior to, or at the time of thrombolysis for ST-elevation myocardial infarction (STEMI) has been shown to reduce patient mortality. This is a class IA recommendation of international guidelines. In routine real-world clinical practice, it is unclear how well this evidence base is applied. The primary objective of this study was to assess the patterns of pharmacotherapy use, especially anti-platelet therapy, at the time of thrombolysis, and on discharge from hospital admission, and assess whether real-world clinical practice conforms to current guideline recommendations.

METHODS: This was a retrospective study carried out in a large regional centre in Victoria, Australia.

RESULTS: 58 STEMI patients were treated by thrombolytic therapy in a pharmaco-invasive model over a 12-month period. 28 of these patients belonged to the locally managed pharmaco-invasive subgroup, and 30 patients belonged to pharmaco-invasive transfer subgroup. At the time of thrombolysis, dual anti-platelet therapy was provided for only 44% of patients in the local subgroup and 50% of patients in the transfer subgroup. Various patterns of dual anti-platelet use were observed, which were not supported by evidence. On discharge from hospital admission, the prescription of dual anti-platelet therapy significantly increased to 88% of patients in the local subgroup (P = 0.02), and 90% of patients in the transfer subgroup (P = 0.002).

CONCLUSION: Clinician adherence to evidence based use of anti-platelet therapy was poor at the time of thrombolysis in a contemporary cohort of Australian STEMI patients. This could represent opportunities to improve care for STEMI patients presenting to regional and rural centres.