More On Managing Acute Myocardial Infarction

Abstract

That Thrombolysis helps reduce mortality in acute myocardial infarction is conclusively established. That aspirin alone or with thrombolysis helps is clear. How then has the debate on cost effectivenessfor countries like Pakistan turned out? In an unplanned an4 erratic manner medical institutions around the country have regularly or intermittently been practicing thrombolysis invariably using the cheaper standard drug streptokinase. Even smaller remote hospitals have beenproviding this service. There is now no going back. The doctors and public are aware ofthe importance ofthrombolysis and rightly demand it. Whether the government hospitals can or cannot afford it, they will now have to provide it. Certainly, anypatient who can afford topayfor the drug and demands it cannot S bedenied the availability ofthronibolysis. As usual, instead ofaplanned entry . into the era ofihrombolysis, we have bumbled into it in a haphazard fasjzion. Wh1e we ire dabbling in thrombolysis, it must hot beforgotten that various adjunct modalities pffer significant advantages and potential for mortality reduction. Aspirin, IV nitrates for continuing pain, IV beta blockade are all proven whelp reduce mortality and morbidity and are affordable and must be employed routinely unless contra - indicated. A medical community which cannot make up its mind will have other forces thrust their decisions on it. In an era ofrapid mass communications, we shall have to be informed, decisive and quick ifwe wish to lead and show the way to correct decisions, or else, our patients and marketforces will continue to lead us.