The pharmacist's role in thrombolytic therapy

Abstract

The pharmacist's role in the administration, appropriate use, and evaluation of thrombolytic agents is discussed. Thrombolytic drugs have been shown to be efficacious when given early in the development of an acute myocardial infarction (AMI). If the drug is to be reconstituted in a central area, there must be immediate response from the pharmacy. If reconstitution is not the pharmacist's responsibility, the pharmacist should still play a role in establishing guidelines for patient selection, drug reconstitution, patient-specific dosing regimens, and concomitant therapy. Pharmacists must also participate in drug-use evaluation. The three thrombolytic agents currently available for the management of AMI are streptokinase, alteplase, and anistreplase. Dosing and reconstitution guidelines for each of these agents are given, and current investigations concerning optimum regimens are summarized. Some of the relative contraindications now used in patient selection need to be examined. It is possible that certain patient subgroups excluded in some trials may benefit from thrombolytic agents. Future clinical trials will provide guidance for the use of thrombolytic agents in these populations. The advent of thrombolytic therapy offers pharmacy an opportunity to expand its role in the drug-use process and to ensure the appropriate use of these agents.