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Updated: Aug 15, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Insights
Streptokinase (SK), APSAC, and rt-PA significantly reduce early mortality in acute myocardial infarction (MI) patients. Accelerated rt-PA with heparin showed superior mortality reduction in the GUSTO trial.
Area of Science:
- Cardiology
- Thrombolytic Therapy
- Acute Myocardial Infarction Management
Background:
- Acute myocardial infarction (MI) poses a significant mortality risk.
- Early reperfusion therapy is crucial for improving outcomes in acute MI.
- Thrombolytic agents have been investigated for their efficacy in reducing MI-related mortality.
Framework:
- Systematic overview of Level I trials evaluating thrombolytic agents.
- Comparison of mortality reduction across different thrombolytic therapies (SK, APSAC, rt-PA) versus placebo.
- Long-term follow-up of early trial benefits.
Implementation:
- Intravenous administration of SK, APSAC, and rt-PA within hours of acute MI onset.
- Direct comparison of mortality outcomes between different thrombolytic regimens.
- Evaluation of accelerated rt-PA combined with heparin in the GUSTO trial.
Implications:
- Established efficacy of SK, APSAC, and rt-PA in reducing early and one-year mortality post-MI.
- The GUSTO trial highlights superior outcomes with accelerated rt-PA plus heparin.
- Evidence supports optimized thrombolytic strategies for acute MI management.
Abstract:
There is unequivocal evidence for the reduction of early mortality (up to about 35 days) by SK, APSAC and rt-PA, each compared with placebo, for patients treated intravenously within the first few hours of onset of acute MI. An overview of early trials demonstrating mortality reduction with SK, has been confirmed by three level I trials of SK, one level I trial of APSAC and one level I trial of rt-PA. The early benefits observed in the large trials of SK, APSAC and rt-PA have persisted at the one-year follow-up. The initial two large trials which directly compared mortalities of therapy with SK, rt-PA and APSAC detected no significant differences. However, the recently presented GUSTO trial has demonstrated greater mortality reduction with accelerated rt-PA plus heparin, compared with regimens of combined rt-PA/SK plus heparin, SK plus iv heparin, and SK plus sc heparin.
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