STREPTOKINASE, TPA, AND HEPARIN IN ACUTE MI.

Controversy continues over the relative merits of streptokinase and tissue plasminogen activator (TPA) in acute myocardial infarction. These two studies compared the two agents and evaluated the effect of adding heparin. The GISSI-2 trial in Italy randomized over 12,000 patients with acute MI to receive either streptokinase alone, streptokinase plus subcutaneous heparin, TPA alone, or TPA plus heparin. Most patients also received aspirin. The combined frequency of in-hospital mortality or severe left ventricular damage (the study end-point) was virtually identical in the four groups (23 percent). The second trial, combining GISSI-2 patients with 8400 patients from 13 countries, analyzed in-hospital mortality. Again, rates were similar in th…