Grasela T H, Green J A
Center for Pharmacoepidemiology Research, School of Pharmacy, State University of New York, Buffalo 14260.
Pharmacotherapy. 1990;10(1):35-41.
In November 1988, 164 hospitals enrolled in the Drug Surveillance Network participated in a nationwide survey of prescribing patterns for thrombolytic drugs for patients with an acute myocardial infarction. The results indicated that alteplase has made dramatic inroads, being used exclusively in 14.6% of the hospitals; in 64% of the hospitals both alteplase and streptokinase were on the formulary. Overall, however, only 17% of patients admitted with an acute myocardial infarction were treated with a thrombolytic, and use of these agents varied markedly across institutions. One of the reasons for this low figure may be the current maximum allowable time from onset of symptoms to administration of a thrombolytic. This time limit was less than 6 hours in the majority of hospitals in spite of recent evidence suggesting that these drugs may be effective up to 24 hours after onset of symptoms. The low and variable use of the agents for acute myocardial infarction suggests the need to identify patient- and physician-related obstacles so that overall attitudes and professional practice can be modified to reverse this trend. Given large number of institutions reporting the presence of formal, prospective, pharmacy-initiated monitoring programs, we suggest that clinical pharmacists will play a major role in implementing the necessary changes.
1988年11月，参与药品监测网络的164家医院参加了一项针对急性心肌梗死患者溶栓药物处方模式的全国性调查。结果表明，阿替普酶已取得显著进展，在14.6%的医院中被单独使用；在64%的医院中，阿替普酶和链激酶均在处方中。然而，总体而言，只有17%的急性心肌梗死入院患者接受了溶栓治疗，而且这些药物的使用在不同机构间差异显著。这一低比例的原因之一可能是目前从症状出现到使用溶栓药物的最大允许时间。尽管最近有证据表明这些药物在症状出现后24小时内可能有效，但大多数医院的这个时间限制仍不到6小时。急性心肌梗死药物的低使用率和使用差异表明，需要找出与患者和医生相关的障碍，以便改变整体态度和专业做法，扭转这一趋势。鉴于大量机构报告存在正式的、前瞻性的、由药房发起的监测项目，我们建议临床药师将在实施必要变革中发挥主要作用。
