[Tissue-type plasminogen activator (t-PA): comments on results of the GISSI-2 study]

12,490 patients from the GISSI-2 trial were randomly allocated to alteplase (recombinant tissue-type plasminogen activator, t-PA) or streptokinase (SK) and beginning 12 hours after the start of thrombolytic therapy to subcutaneous heparin or no heparin. No significant differences in hospital mortality were found between the two thrombolytic treatments as well as between heparin and no heparin administration. The incidence of major cardiac complications was also very similar in the different groups. The incidence of major bleedings was significantly higher in SK and heparin treated patients, whereas the overall incidence of stroke was similar in all groups. SK and t-PA with or without post-thrombolytic heparin treatment appear equally effective and safe for use in routine conditions care, in all patients with acute myocardial infarction (AMI).