2. ACTION
Recombinent streptokinase and plasminogen
together form a stochiometric 1:1 activator complex.
Activator complex converts remaining plasminogen,
present either in the blood or in a thrombus to
plasmin.
Plasmin lyses thrombi by converting insoluble fibrin
into soluble fibrin degradation products.
3. The plasma half-life of the activator complex is
around 20 minutes. Following IV administration, the
effect on coagulation may persist for up to 12
hours.
Recombinent streptokinase is weakly antigenic and
may be neutralized by anti-streptokinase
antibodies, normally present in the blood as a result
of previous streptococcal infections.
4. A fibrinolytic state is initiated when the amount of
recombinant streptokinase administered exceeds
the anti-streptokinase antibody titre.
Thrombolysis commences when the streptokinase
activator complex diffuses into the thrombus.
5. INDICATIONS
Acute myocardial infarction: less than 12 hours
Deep venous thrombosis: less than 14 days
Acute massive pulmonary embolism
Acute arterial thrombosis and embolism.
Clotting in haemodialysis shunts.
6. CONTRAINDICATIONS
Since thrombolytic therapy increase the risk of
bleeding, it is contraindicated in the following
situations:-
Recent (<10 days) trauma (eg facial or head
trauma) or traumatic procedures (eg surgery,
biopsy or invasive diagnostic procedure).
Several uncontrolled hypertension.
7. Recent cerebrovascular events (eg stroke) within
the last 2 months or intracranial malignancy.
Potential for internal bleeding (eg peptic ulcer,
ulcerative colitis, diverticulitis or visceral tumors)
including thrombocytopenia.
8. All forms of reduced blood coagulability, in
particular spontaneous fibrinolysis and extensive
clotting disorders.
Pronounced hepatic and renal dysfunction.
Recombinant streptokinase is also contraindicated
in patients with potential for cardiac embolism (eg
bacterial endocarditis)
9. DOSAGE AND ADMINISTRATION
1. Acute myocardial infarction
15,00,000 IU of streptokinase in 50 ml of
physiological saline or dextrose 5% is administered
as an intravenous infusion at a constant rate cover
over 30-60 minutes.
To ensure that the contents of the vial are rapidly
and completely reconstituted, 5 ml of physiological
saline should be first injected into vacuum vial and
the residual vacuum abolished by briefly loosening
the needle from the syringe.
10. For dissolution, the vial needs to be swirled gently
and shaking avoided to prevent foaming.
This reconstituted solution should then be diluted
further in an infusion bottle with physiological saline
or dextrose 5% in preparation for infusion.
11. Streptokinase should be administered as soon as
possible after onset of symptoms of myocardial
infarction.
The greatest benefit in mortality reduction is
achieved when recombinant streptokinase is
administered within the first 6 hours but substantial
benefit has been demonstrated at up to 12 hours.
12. 2. Deep venous thrombosis, pulmonary embolism
and arterial occlusions:
The standard dosage comprises an initial loading
dose sufficient to overcome the circulating anti-
streptokinase antibodies, followed by a
maintenance infusion to sustain a continuous
systemic lytic state.
13. The loading dose of 2,50,000 IU dissolved in 100-
300ml of physiological saline or dextrose 5% should
be administered intravenously over 30 minutes.
This is followed by a maintenance infusion of
1,00,000 IU per hour (dissolved in physiological
saline or dextrose 5%) administered for up to 3
days. If possible, an angiographic assessment
should then be performed. If no clinical effect is
noted after 3 days, treatment should be
discontinued. Streptokinase therapy may otherwise
be continued for an additional 1-3 days if
considered necessary.
14. 3. Clotting in haemodialysis shunts
It is dissolved in physiological saline. 10,000-25,000
IU are deposited in the clotted part of the shunt and
it is sealed on the venous side by forceps.
A sterile single dose syringe is attached on the
arterial side to form an air cushion against which
the artery can pulsate. If necessary, this treatment
may be repeated after 30-45 minutes.
15. FOLLOW-UP TREATMENT
After every course of recombinant streptokinase
therapy, a follow-up treatment with anticoagulants
or platelet aggregation inhibitors can be instituted
as a prevention of rethrombosis.
With heparin therapy, in particular, an increased risk
of haemorrhage must be considered.
16. ADVERSE EFFECTS
COMMON
Hypotension/bradycardia in about 10% of the
cases.
Allergic reactions such as fever, chills,
gastrointestinal symptoms, generalized exanthema
and muscoskeletal pain may occur, but usually
respond well to symptomatic therapy.
Minor bleedings from punctures and surgical sites.
17. LESS COMMON
Tachycardia
Major haemorrhagic episodes requiring transfusion
and entailing termination of streptokinase
administration.
Menstrual bleeding may be aggravated.
Mild allergic effects such as headache, nausea,
vomiting, flushing and urticaria.
Musculoskeletal pain including myalgia and back
pain.
18. RARE
Anaphylactic and anaohylactoid reactions ranging
in severity from mild dyspnoea to bronchospasm.
Anaphylactic shock and delayed hypersensitivity
reactions such as arthritis, arthralgia, vasculitis and
intestitial nephritis.
Pulmonary embolism.
Neuropathy