Guidelines for general practitioners administering thrombolytics.

Acute myocardial infarction (AMI) recognises no boundaries, and the patient's greatest need occurs at the interface between primary care and hospital system. Ideally, the general practitioner, if summoned, should be able to provide resuscitation, analgesia with opiates, and thrombolytic therapy. Thrombolytics should certainly be given to eligible patients by the general practitioner if an hour could be saved by so doing. Optimising the risk-benefit ratio for thrombolytic therapy given in the community is a challenge to clinical judgement. Experience with this potent treatment is best obtained under a degree of supervision, which could take the form of an audit of the prehospital management of suspected AMI. With prehospital administration of thrombolytic therapy at the first opportunity, the chances of saving a life are better than 1 in 10, while the excess risk of a disabling stroke is about 1 in 1000.