Acronym: International Study of Infarct Survival
Purpose: To compare the efficacy of sreptokinase versus tPA versus anistreplase including with aspirin alone or in combination with aspirin and heparin.
Format: Randomized, multi-center, double blind, placebo controlled trial - 3 x 2 factorial trial
Treatment Group: Either streptokinase or tPA or anistreplace AND aspirin or combination of aspirin and heparin.
Control Group: None
Number of Patients: 41,299
Suspected acute myocardial infarction
No contraindication to study drugs
Contraindication to study drug
Follow-up: 6 months
Primary Endpoint: All-cause mortality
Secondary Endpoint: Major bleeding
Randomized acute MI patients to either streptokinase OR tPA OR anistreplase with the addition of aspirin and heparin OR aspirin alone. Each thrombolytic agent was similar in primary endpoint of 35 day mortality. There was increased bleeding when heparin was used with the thrombolytic agent including intracranial hemorrhage with small reduction in death which ceased once heparin was stopped.
Lancet. 1992 Mar 28;339(8796):753-70.