GISSI-2 trial

20891 patients who were admitted to hospital within 6 hr of the onset of symptoms of acute myocardial infarction were randomised to:

Thrombolysis:

• streptokinase (1.5 MU over 30-50 min)
• t-PA (100 mg over 3 hr)

Anticoagulation:

• aspirin daily for 30 days (325 mg)
• aspirin daily for 30 days plus subcutaneous heparin (12500 IU subcutaneous twice daily)

There were no significant differences in the 35 day mortality rates between:

• streptokinase and t-PA
• aspirin and aspirin+heparin

There was a small, but significant, increased incidence of stroke associated with t-PA.

Reference:

• Gruppo Italiano per lo Studio dell Streptochinasi nell' Infarcto Miocardico (GISSI). GISSI-2: A factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12490 patients with acute myocardial infarction. (1990). Lancet, 336, 65-71.
• In hospital mortality and clinical course of 20891 patients with suspected acute myocardial infarction randomised between alteplase and streptokinase with or without heparin. (1990). Lancet, 335, 71-5.