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15059 patients presenting within 6 hours of the onset of symptoms of acute myocardial infarction were randomized to treatment with reteplase or alteplase.

Reteplase was administered as two boluses of 10 MU separated by 30 min. Alteplase was given as an accelerated infusion of up to 100 mg over 90 min.

Mortality at 30 days was:

  • 7.47% for reteplase
  • 7.24% for alteplase
  • p=0.54, 95% confidence interval for absolute difference in mortality rates -1.1 to 0.66%

The rate of complications was the same in both arms.

Reteplase may be given as a bolus and hence may be more convenient, however alteplase is as effective.


  • The GUSTO investigators. (1997). A comparison of reteplase with alteplase for acute myocardial infarction. New Engl. J. Med. 337, 1118-23.

Last reviewed 01/2018