The Ideal Thrombolytic Agent: GISSI-2 and ISIS-3

Streptokinase (SK) and tissue plasminogen activator (alteplase [tPA]) are by far the most intensively studied thrombolytic agents, but only recently a direct head-to-head comparison (GISSI-2 Trial, in which 12,490 patients have been randomized) has become available to the scientific community. This trial, with its international extension (the International tPA/SK Mortality Trial) recruited more than 20,000 patients, showed that the two drugs tested (SK and tPA) were substantially comparable as far as the clinical events were considered. ISIS-3, the largest randomized clinical trial ever performed, compares SK, tPA, and APSAC in a factorial design. Its results will be available before spring, 1991. It is likely that these two studies, if the results will be consistent, will give a definitive answer about comparison among thrombolytic drugs. As a consequence of that achievement, the interest of the scientific community will possibly be directed towards the long-term prevention of the infarct complications, namely ventricular remodeling and infarct expansion or life-threatening arrhythmias.