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The following trials have compared thrombolysis started before hospital admission with that started in hospital:
The GREAT trial showed that patients who were given immediate thrombolysis in the community had a lower mortality when compared to patients who received thrombolysis in hospital. The GREAT trial reveal that for patients who could receive thrombolysis two hours after the start of symptoms, each hour's delay increases the mortality risk by 21 lives per 1000 within 30 days and 69 lives per 1000 within 30 months.
EMIP and MITI found the benefits of community-initiated thrombolysis to be less marked. The discrepancy may stem from the short delays before starting in-hospital thrombolysis in these two trials which tends to reduce the advantages of therapy initiated in the community.
Such data prompted the British Heart Foundation to recommend that thrombolysis should not be delayed beyond 60 min after the onset of symptoms and certainly not beyond 90 min.