Letters
Cardiovascular diseases
Volume 185 - Issue 5

Guidelines for the management of acute coronary syndromes 2006

Author:  Andrew J Bezzina

Med J Aust 2006; 185 (5): 294-295. || doi: 10.5694/j.1326-5377.2006.tb00569.x
Published online: 4 September 2006
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To the Editor: The discussion of fibrinolysis in the recently published guidelines for the management of acute coronary syndromes 20061 is interesting. The recommendations clearly indicate that second-generation agents should be preferred to streptokinase in all circumstances. The guidelines reference the GUSTO-I trial data2 as the primary support for those recommendations. These data are, at best, debatable in terms of showing any benefit of front-loaded tissue plasminogen activator over streptokinase, and then only in limited circumstances (ie, patients aged less than 75 years with anterior infarcts and within 4 hours of the onset of symptoms).3,4

To my knowledge, there have been no head-to-head trials of this size of the other fibrinolytic agents discussed against streptokinase. Thus there is no justification for the blanket superiority that is accredited to these agents, both by implication and explicitly, in the guidelines.

It is a matter of some concern that guidelines from such respected groups should make statements that will be used broadly by clinicians, but that go beyond the evidence base to which they refer.

On the balance of information available there is no compelling case to relegate streptokinase from the front line.

Author

  • Andrew J Bezzina1
  • 1. Wollongong Hospital, Wollongong, NSW.

Correspondence: Andrew.Bezzina@sesiahs.health.nsw.gov.au

References

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