Problem Suspected acute MI
Format Randomised controlled trial
Treatment (streptokinase OR tPA OR anistreplase) AND (aspirin + heparin OR aspirin alone)
Control -
Population 41299
Inclusion criteria -
Exclusion criteria -
Follow-up 6 months
Primary endpoint 35-day mortality
Secondary endpoint(s) -
Details .
Brief summary: UFH no benefit added to aspirin without PCI. 3 thrombolysis agents similar.
PAPER: ISIS-3: a randomised comparison of streptokinase vs tissue plasminogen activator vs anistreplase and of aspirin plus heparin vs aspirin alone among 41,299 cases of suspected acute myocardial...
Date 28 Mar 1992
Journal Lancet. 1992 Mar 28;339(8796):753-70.
Information Aspirin + Heparin (vs aspirin alone)
-No significant medium-term survival advantage
-Slightly fewer deaths during heparin treatment, but may cease when heparin stops
-No significant difference with respect to total stroke
-Excess of major non-cerebral bleeds
-Excess of definite or probable cerebral haemorrhage

Anistreplase (APSAC) vs. Streptokinase
-No significant difference in re-infarction, similar 6 month survival
-More allergy, slight excess strokes

rtPA (vs. Streptokinase)
-No significant difference in mortality
-Fewer reinfarctions
-Increased stroke (attributed to cerebral haemorrhage)