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Streptokinase

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Anaesthetics and Critical Care

Obstetrics Gynaecology

Trauma and Orthopaedics

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Urology

Version Jan 2023

Initial hypotension managed with IV fluids and raising the foot of the bed and slowing the infusion

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Derived from Group A Beta haemolytic streptococci
Rate of major bleeding (requiring transfusion) of 0.3-0.5%

Action

Cleaves plasminogen to form plasmin
Streptokinase will cause lysis of haemostatic fibrin
Creates an antibody response which if given again reduces the effectiveness

Indications

STEMI - reduces mortality
Pulmonary embolism with significant compromise
Large DVT with significant compromise

Dose

Name	Starting Dose	Frequency	Route
Streptokinase (STEMI)	1,500,000 IU within 60 min in 100 ml of 0.9% Saline	stat	IV
Streptokinase (PE with haemodynamic compromise)	250,000 IU over 30 min and then 100,000 IU/hr for 24 hours. Take expert advice. Used in a small minority of patients	stat	IV
Streptokinase (Large DVT)	250,000 IU/30 min and then 100,000 IU/hr for 72 hours. Take expert advice. Used in a small minority of DVT/PE	stat	IV

Interactions

Bleeding risk with Clopidogrel and Warfarin
In STEMI used with Aspirin and other antiplatelets
Extensive DVT, Arterial Thrombosis or Embolism
Not advocated for stroke thrombolysis

Cautions

Increases Bleeding risk so needs extreme caution and balancing of risk vs benefits

Contraindications

Aneurysm, Brain or spinal AVMs
Bleeding problems or problems with blood clotting
Diabetic retinopathy, Head injury or intracranial tumour
Severe Hypertension, Recent biopsy or surgery or trauma
Allergic reaction to streptokinase
Pregnancy or breast-feeding, Warfarin treatment
Active internal bleeding,Intracranial neoplasm
Recent (within 2 months) cerebrovascular accident, intracranial or intraspinal surgery
Severe uncontrolled hypertension

Side effects

Bleeding, Fever and shivering, occurring in 1-4% of patients
Allergic/anaphylactic/anaphylactoid reactions
Hypotension, not secondary to bleeding or anaphylaxis has been observed in 1% to 10% of patients. Bed rest, the elevation of foot of bed and IV fluids may be given and the infusion rate slowed.
Cholesterol Embolism

Monitoring

Reduces plasminogen and fibrinogen
Increases thrombin time (TT), activated partial thromboplastin time (APTT), prothrombin time (PT)
Changes usually normalize within 12-24 hours

References

Streptokinase in BNF

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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