GUSTO II trial

The GUSTO II study investigated the role of the thrombin-specific inhibitor hirudin in the treatment of myocardial infarction.

• GUSTO-IIa - stopped early because of intracerebral haemorrhages (1)
  • re-initiated at lower dose of hirudin (see GUSTO-IIb)
  • Hirudin (vs. heparin)
    • greater incidence of stroke
    • even greater difference in those treated with thrombolysis
    • indication that APTT useful for predicting stroke risk in thrombolysis patients
      
      
• GUSTO-IIb (Lower dose of Hirudin vs. GUSTO-IIa) (2)
  • Hirudin (vs. Heparin)
    • significantly reduced risk of death or MI at 24hr
    • no significant difference at 30 days

Reference:

• Circulation. 1994 Oct;90(4):1631-7.
• N Engl J Med. 1996 Sep 12;335(11):775-82.