Trial Details:

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

Inclusion Criteria:

  • Suspected acute myocardial infarction
  • No contraindication to study drugs

Exclusion Criteria:

  • 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.

Original Publication:

Lancet. 1992 Mar 28;339(8796):753-70.