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ISIS-3 trial

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

41299 patients entering hospital up to 24 hr after the onset of symptoms of acute myocardial infarction were randomised to:

  • thrombolysis:
    • streptokinase (1.5 MU infused over 1 hr)
    • t-PA (0.60 MU/kg infused over 4 hr)
    • APSAC (30 U over 30 min)

  • anticoagulation:
    • aspirin alone (162 mg/day)
    • aspirin plus subcutaneous heparin (12500 IU starting at 4 hr, given twice daily for 7 days)

The study showed that there was no significant difference in the mortality and complication rates between the three thrombolytic groups.

There was a small, but significant, deficit in re-infarctions in the t-PA group. Streptokinase had a small but significant deficit in non-cerebral bleeds. APSAC and streptokinase were associated with a higher frequency of allergic and hypotensive episodes.

ISIS-3 suggests that the use of heparin and aspirin rather than aspirin alone resulted in a slightly lower mortality rate in the short-term (although there was no effect at 6 months).

Reference:

  • ISIS-3: a randomised comparison of streptokinase vs. tissue plasminogen activator vs. anistreplase and of aspirin plus heparin vs. aspirin alone among 41299 cases of suspected acute myocardial infarction. (1992). Lancet, 339, 753-770.

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