| Summary: | Myocardial infarction is an acute coronary syndrome in which the heart muscle undergoes injury due to ischemia (lack of blood supply). Most myocardial infarctions occur out-of-hospital, with nearly 79 percent occurring at home and nearly 15 percent in public places (e.g., shopping malls and stores, streets and highways, recreation facilities, office buildings, hotels). The clinical management of out-of-hospital myocardial infarctions requires the most rapid assessment and initiation of treatment possible to ensure optimal patient outcomes. Once a diagnosis is made, the goals of therapy are to decrease mortality and complications, limit the infarct size, and re-establish blood flow to the affected artery. In the absence of contraindications, thrombolytics administered as soon as possible after symptom onset are part of the treatment arsenal frequently given to patients following a myocardial infarction. The purpose of thrombolytics (also known as fibrinolytics) is to break up the thrombus (blood clot) that obstructs the affected artery, in order to restore blood flow. In Canada, the thrombolytics alteplase and tenecteplase are currently available for use. These are a synthetic form of tissue plasminogen activator, which convert plasminogen, bound to fibrin clots, to plasmin resulting in the degradation of the clot. However, a re-infarction is possible and underscores the need for prompt transfer of the patient to a hospital for an invasive assessment and possible percutaneous coronary intervention. In addition, when the drug is administered in a prehospital setting, the ability to safely manage adverse events and the optimum protocol remains unclear. The objective of this report is to evaluate the safety and evidence-based guidelines regarding thrombolytic administration for the treatment of acute myocardial infarction in prehospital settings
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