Mistaken beliefs about withholding thrombolysis for patients with diabetes mellitus and an acute myocardial infarction

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The benefits of thrombolysis in people with diabetes and an acute myocardial infarction are well grounded. Life saving treatment may be inappropriately withheld due to concerns regarding retinal haemorrhage and subsequent visual impairment. We believe that all patients with an acute anterior myocardial infarction and diabetes should be considered for thrombolysis, irrespective of their retinal appearance. We therefore audited our junior doctors to assess their views on thrombolytic treatment in patients with differing degrees of diabetic eye disease.The participating doctors were provided with the case of a man with long-standing type 2 diabetes and an acute anterior myocardial infarction, along with five unlabelled retinal photographs including a normal eye, background diabetic retinopathy, pre-proliferative retinopathy, proliferative retinopathy, and maculopathy. The doctors were then asked if the patient should or should not receive thrombolysis.One quarter of the doctors surveyed would not give thrombolysis in the presence of a normal retina or background disease. A quarter would not give thrombolysis with maculopathy and two thirds would not treat in the presence of pre-proliferative retinopathy. Over two thirds would not treat those with proliferative disease.Although more senior doctors were more likely to give thrombolysis in the presence of increasing diabetic eye disease than their juniors colleagues, these results suggest that some patients may not receive appropriate potentially life saving therapy. Better education of junior doctors to avoid this oversight is therefore necessary. Copyright © 2007 John Wiley & Sons.

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