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Previous Volume 336:847-860 March 20, 1997 Number 12 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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In this article, we review the randomized clinical trials of aspirin, of heparin, and of fibrinolytic therapy in patients with suspected acute myocardial infarction to determine which of these treatments have been shown to improve survival and other major clinical outcomes.

Aspirin

Benefits of Aspirin during and after Suspected Myocardial Infarction

The Second International Study of Infarct Survival (ISIS-2) demonstrated conclusively the substantial value of aspirin therapy in patients with suspected acute myocardial infarction¹ (and other studies have shown the value of aspirin in patients with unstable angina²). In the ISIS-2 trial, assignment to one month of treatment with 162.5 mg of enteric-coated aspirin per day (with the first . . . [Full Text of this Article]

Benefits in Different Types of Patients

Value of Wider Use of Aspirin

Recommendations for Routine Aspirin Therapy

Heparin

Addition of Standard Heparin Regimens to Aspirin

Addition of More Intensive Heparin Regimens to Aspirin

Bleeding with More Intensive Heparin Regimens

Avoidance of Routine Heparin Therapy in Acute Myocardial Infarction

Fibrinolytic Therapy

Benefits of Fibrinolytic Therapy in Patients with St-Segment Elevation or Bundle-Branch Block

Delay from Onset of Symptoms to Fibrinolytic Therapy

Benefits in Elderly and Other High-Risk Patients

Recommendations for Routine Fibrinolytic Therapy

Different Fibrinolytic Regimens

Coronary-Artery Patency versus Cerebral Hemorrhage

Evidence from Large, Randomized Trials and Avoidance of Selective Emphasis

Risks of Stroke with Different Fibrinolytic Regimens

Deaths Not Related to Stroke

Lack of Difference in Net Clinical Outcome with Different Fibrinolytic Regimens

General Problems of Unduly Selective Emphasis

Implications for Clinical Practice

Source Information

From the Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.

Address reprint requests to Professor Collins at the Clinical Trial Service Unit and Epidemiological Studies Unit, Radcliffe Infirmary, Oxford OX2 6HE, United Kingdom.

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