17187 patients entering 417 hospitals a median of 5 hours after the onset of the symptoms of acute myocardial infarction were randomised with placebo control to:
- a 1 hr i.v. infusion of 1.5 MU of streptokinase
- one month of 160 mg/day enteric-coated aspirin
- both of the above
- none of the above
Both streptokinase and aspirin reduce mortality when compared to placebo:
- streptokinase alone: 9.2% vs. 12.0% (2p < 0.00001)
- aspirin alone: 9.4% vs. 11.8% (2p < 0.00001)
The use of both agents together gave a synergistic reduction in mortality:
- aspirin + streptokinase: mortality = 8.0%
- placebo: mortality = 13.2%
- this represents an odds reduction for death of 42%
There was no significant increase in serious side-effects such as intracranial haemorrhage or bleeds requiring transfusion.
- Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17187 cases of suspected acute myocardial infarction: ISIS-2. (1988). Lancet, 2, 349-60.
Last reviewed 01/2018