What are best practices for thrombolytic therapy in the out-of-hospital setting?

Updated: Aug 04, 2021
  • Author: Wanda L Rivera-Bou, MD, FAAEM, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Most EMS systems now use tissue plasminogen activator (tPA; alteplase) or modified forms of tPA (eg, reteplase or tenecteplase). The modified agents offer convenient single- or double-bolus dosing, making them preferable for fibrinolysis in the prehospital setting.

For EMS systems to implement out-of-hospital thrombolytic programs, several quality standards are required. Protocols must include thrombolytic checklists, 12-lead ECG interpretation and transmission, personnel trained in advanced cardiac life support (ACLS), and 24-hour availability of medical direction. These programs should also incorporate an adequate quality evaluation process for evaluation of efficacy and safety.

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