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Issues raised by GUSTO
1Green Lane Hospital, Auckland, New Zealand.
The GUSTO trial raises several questions including the role of heparin in thrombolysis. The need for intravenous versus subcutaneous heparin with streptokinase (SK) has not been clarified in this trial. It is more likely that the superiority of tissue plasminogen activator (t-PA) was due to its accelerated administration rather than the accompanying heparin. Despite the improvement in survival, much is still to be achieved in obtaining optimal reperfusion rates.
The GUSTO trial raises several questions including the role of heparin in thrombolysis. The need for intravenous versus subcutaneous heparin with streptokinase (SK) has not been clarified in this trial. It is more likely that the superiority of tissue plasminogen activator (t-PA) was due to its accelerated administration rather than the accompanying heparin. Despite the improvement in survival, much is still to be achieved in obtaining optimal reperfusion rates.