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September 2, 1993New England Journal of MedicineOpen Access

An International Randomized Trial Comparing Four Thrombolytic Strategies for Acute Myocardial Infarction

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Why the study?

Does accelerated t-PA with intravenous heparin reduce 30-day mortality compared to streptokinase regimens in patients with evolving acute myocardial infarction?

Population

41,021 patients with evolving acute myocardial infarction across 15 countries and 1081 hospitals.

Comparison

Accelerated tissue plasminogen activator with… vs Streptokinase with subcutaneous heparin, or…

Design

RCT, Randomly assigned to four different thrombolytic strategies

Follow-up

30 days

Discussion

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Overview

Accelerated t-PA with heparin should replace streptokinase as preferred reperfusion in AMI; confirms mortality benefit in this RCT.

Structured PICO

Does accelerated t-PA with intravenous heparin reduce 30-day mortality compared to streptokinase regimens in patients with evolving acute myocardial infarction?

P
Population
41,021 patients with evolving acute myocardial infarction across 15 countries and 1081 hospitals.
I
Intervention
Accelerated tissue plasminogen activator (t-PA) with intravenous heparin, or a combination of streptokinase plus t-PA with intravenous heparin.
C
Comparator
Streptokinase with subcutaneous heparin, or streptokinase with intravenous heparin.
O
Outcome
30-day mortalityhard clinical

Accelerated t-PA with intravenous heparin provides a significant survival benefit over standard streptokinase regimens in acute myocardial infarction, despite a small increase in hemorrhagic stroke.

Cite This Study

A 1993 study studied this question.

synapsesocial.com/papers/6a7c972c178e986690cf7fcfhttps://doi.org/10.1056/nejm199309023291001
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