Streptokinase
Mechanism :
Streptokinase, acts with plasminogen to produce an "activator complex" that converts plasminogen to the proteolytic enzyme plasmin. The mechanism by which dissociated streptokinase is eliminated is clearance by sites in the liver; however, no metabolites of streptokinase have been identified. Plasmin degrades fibrin clots as well as fibrinogen and other plasma proteins.
Indication :
- Acute myocardial infarction: within 12 hours of onset with persistent ST-segment elevation or recent left bundle-branch block.
- Has been used for pediatric thrombolysis (off- label) and intrapleural for empyema.
Contraindications :
Contraindicated in patients with recent trauma or surgery, coagulation defects, history of cerebrovascular disease, parturition within the last 10 days, heavy vaginal bleeding, oesophageal varices, peptic ulceration. Also, severe hypertension, known intracranial neoplasm, severe liver disease, acute pancreatitis and previous severe allergic reactions to streptokinase or streptokinase-containing products. There is an increased risk of hemorrhage in patients who are receiving or who have recently been treated with anticoagulants or antiplatelet drugs. Streptokinase should not be given to patients who have had a recent streptococcal infection or who have received streptokinase more than 5 days and less than 12 months previously, due to formation of antibodies.
Dosing :
Safety not established in children.
Adults:
Acute myocardial infarction:
Systemic administration: A single dose of 1.5 million IU streptokinase should be infused intravenously over one hour.
Local intracoronary administration: A bolus of 20,000 IU streptokinase should be followed by a maintenance infusion of 2,000 IU to 4,000 IU per minute over 30 to 90 minutes depending on the achievement of coronary artery patency.
Arteriovenous cannula occlusion:
250,000 IU in 2 ml IV solution in each cannula limb over 25-35 min. Clamp cannula for 2 hours. Aspirate, flush, and reconnect.
Venous thrombosis, arterial thrombosis and embolism:
250,000 IU IV over 30 min. Then 100,000 IU/hour IV for 72 hours for DVT and 100,000 IU/hour for 24-72 hours.
Adverse Effect :
Haemorrhage at the injection site, ecchymoses, gastrointestinal bleeding, genitourinary bleeding, epistaxis, development of antistreptokinase antibodies, allergic anaphylactic reactions, e.g. rash, flushing, itching, urticaria, angioneurotic oedema, dyspnoea, bronchospasm, hypotension, hypotension, tachycardia, bradycardia, pyrexia, nausea and vomiting, bleeding. Allergic/anaphylactic reactions have been reported.
Interaction :
Use of Anticoagulants and Antiplatelet Agents: Streptase, Streptokinase, alone or in combination with antiplatelet agents and anticoagulants, may cause bleeding complications.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in normal renal function |
| HD | Not dialysed. Dose as in normal renal function |
| HDF/High flux | Unlikely to be dialysed. Dose as in normal renal function |
| CAV/VVHD | Not dialysed. Dose as in normal renal function |
Hepatic Dose :
No dosage adjustments are recommended.