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Related Subjects: |Hypertension |Cardiac Thrombolysis |Stroke Thrombolysis |Alteplase |Tenecteplase |Streptokinase |Reteplase

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

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