Streptokinase

Indications

Streptokinase is used for: Acute Evolving Myocardial Infarction, Acute Massive Pulmonary Embolism, Deep Vein Thrombosis, Arterial Thrombosis or Embolism, Arteriovenous Cannulae Occlusion.

Adult Dose

Intravenous Acute myocardial infarction Adult: 1.5 million units as a single dose infused over 1 hr immediately after onset of symptoms. Pulmonary thromboembolism ; Arteriovenous occlusions Adult: Loading dose: 250,000 units infused over 30 min. Maintenance: 100,000 units/hr for 24-72 hr depending on the condition to be treated. For cerebral retinal thrombosis, 12 hr may be sufficient. Monitor treatment by maintaining thrombin clotting time at 2-4 times normal values.

Child Dose

Intravenous Pulmonary thromboembolism ; Arteriovenous occlusions Child: Loading dose: 2500-4000 units/kg over 30 min, followed by infusion of 500-1000 units/kg/hr, continued until reperfusion occurs, up to 3 days. Initial dose may be estimated by streptokinase resistance test. Monitor treatment by maintaining thrombin clotting time at 2-4 times normal values.

Renal Dose

Administration

Contra Indications

Severe hypertension, recent stroke, cerebral neoplasm, recent history of peptic ulcer disease, ulcerative colitis, pancreatitis, subacute bacterial endocarditis, coagulation defects also due to liver or kidney disease, recent surgery, childbirth. Hypersensitivity, increased risk of cerebral bleeding, trauma. Pregnancy. Active internal bleeding, bleeding GI lesions. Arteriovenous malformation or aneurysm; recent (within 10 days) facial or head trauma, intracranial or intraspinal surgery, More than 5 days and less than 12 months since previous Streptokinase therapy.

Precautions

Mitral stenosis associated with AF. Streptokinase treatment within last 12 mth, use after prolonged or traumatic CPR; diabetic retinopathy. Elderly.

Pregnancy-Lactation

Interactions

Antagonistic effects with antifibrinolytic agents e.g. aminocaproic acid. Potentially Fatal: Anticoagulants, heparin, antiplatelet agents e.g. aspirin and dipyridamole affect platelet function increasing the risk of haemorrhage.

Adverse Effects

Side effects of Streptokinase : Fever, chills, back pain, abdominal pain, nausea, vomiting, arrhythmia, bruising, rash, pruritus, acute renal failure due to embolism and haemorrhage. Cerebral, peripheral and pulmonary embolism. Allergic reactions, liver enzyme abnormalities, hypotension. Potentially Fatal: Haemorrhage; anaphylactic shock.

Mechanism of Action

Streptokinase forms a complex with plasminogen which then converts plasminogen to plasmin. Plasmin breaks down clots as well as fibrinogen and other plasma proteins.