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February 1, 2003QJM

Thrombolytic agents showed no significant differences in 30-35 day mortality, but total stroke rates were lower for streptokinase than for all alteplase combined (OR 1.29; 95% CI 1.13-1.46).

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Why the study?

Do different thrombolytic agents differ in reducing 30-35 day mortality and major adverse effects in patients with acute myocardial infarction?

Population

142,907 patients in the early stages of acute myocardial infarction from 14 randomized controlled trials

Comparison

Thrombolytic agents vs Alternative thrombolytic agents

Design

Meta-analysis

Follow-up

30-35 days

Key result

Thrombolytic agents showed no significant differences in 30-35 day mortality, but total stroke rates were lower for streptokinase than for all alteplase combined (OR 1.29; 95% CI 1.13-1.46).

Authors

YDY Dündar

Discussion

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Overview

Equivalent mortality reduction across thrombolytics in AMI; challenges GUSTO-I alteplase superiority while confirming streptokinase's lower stroke risk.

Study Design

Type

Systematic Review (n=142,907)

Structured PICO

Do different thrombolytic agents differ in reducing 30-35 day mortality and major adverse effects in patients with acute myocardial infarction?

P
Population
142,907 patients in the early stages of acute myocardial infarction from 14 randomized controlled trials
I
Intervention
Thrombolytic agents (reteplase, tenecteplase, alteplase, or streptokinase)
C
Comparator
Alternative thrombolytic agents (alteplase vs. streptokinase, reteplase vs. streptokinase or alteplase, tenecteplase vs. alteplase)
O
Outcome
Mortality at 30-35 dayshard clinical

All evaluated thrombolytic drugs appear to have similar efficacy in reducing 30-35 day mortality in acute myocardial infarction, though streptokinase is associated with lower stroke rates compared to alteplase.

Limitations

  • Debate remains over whether accelerated alteplase is sufficiently different from other alteplase regimens to be excluded from meta-analysis, and whether meta-analyses outweigh single large trials.

Cite This Study

Y Dündar (2003) conducted a systematic review in acute myocardial infarction (n=142,907). Thrombolytic agents (reteplase, tenecteplase, alteplase) vs. Streptokinase was evaluated on 30-35 day mortality. Thrombolytic agents showed no significant differences in 30-35 day mortality, but total stroke rates were lower for streptokinase than for all alteplase combined (OR 1.29; 95% CI 1.13-1.46).

synapsesocial.com/papers/6a1c07cc5b8f4ede65a96b82https://doi.org/10.1093/qjmed/hcg016
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Thrombolysis in acute myocardial infarction: analysis of studies comparing accelerated t-PA and streptokinase.1999 · 12 citations
  2. 2Comparative efficacy of common thrombolytics in acute ischaemic stroke: a network meta-analysis2026
  3. 3Comparison of the efficacy and safety of different thrombolytic drugs in the treatment of acute ischemic stroke within 4.5 h: a systematic review and network meta-analysis2026
  4. 4Current issues concerning thrombolytic therapy for acute myocardial infarction1995 · 29 citations
  5. 5Thrombolysis for Acute Myocardial Infarction: Making Sense of The Clinical Trials Data1992 · 7 citations