The use of thrombolytic therapy is currently a major aspect of the care of patients with acute myocardial infarction (AMI) and should probably be afforded the same priority as patients in cardiac arrest (Quinn 1999). This paper will outline the actions and use of thrombolytic therapy, examining the two most common thrombolytic drugs used in the UK, in the acute management of AMI. Thrombolysis in relation to national guidelines will be considered. With the emphasis on reduced door-to-needle times, the appropriate places for the administration of thrombolysis will be reviewed. The ‘fast-track’ admission response is discussed involving direct paramedic admissions to the coronary care unit (CCU), together with the administration of thrombolysis in A&E departments.