STREPTOKINASE

Fibrinolytic medicine. Enzyme secreted by several species of Streptococci that can bind and activate human plasminogen, which degrades fibrin and so breaks up thrombi

Dosage Forms

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Powder for injection

250,000 IU

Uses

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  • Acute myocardial infarction
  • Deep vein thrombosis
  • Pulmonary embolism
  • Acute arterial occlusion
  • Central retinal venous or arterial thrombosis

Dose and Duration

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Acute myocardial infarction

Adult: by IV infusion, 1,500,000 IU over 60 minutes preferably within 1 hour of infarction, though can be used within 12 hours.

Thrombosis

Adult and child over 12 years: by IV infusion, 250,000 IU over 30 minutes followed by 100,000 IU every hour for 12–72 hours.

Child 1 month–12 years: by IV infusion, 2,500–4,000 IU/kg over 30 minutes followed by 100,000 IU every hour for 12–72 hours.

Adjust dose based on condition and monitoring parameters.

Preparation

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  • Reconstitute with normal saline solution and dilute further with normal saline or dextrose 5%.

Contra-indications

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  • Repeat use of streptokinase beyond 4 days of first use
  • Recent haemorrhage, surgery (including dental), parturition or trauma
  • Heavy vaginal bleeding
  • Haemorrhagic stroke
  • History of cerebrovascular disease
  • Coma
  • Severe hypertension
  • Coagulation defects
  • Bleeding diatheses
  • Aortic dissection
  • Risk of gastrointestinal bleeding
  • Acute pancreatitis
  • Severe liver disease
  • Acute pulmonary disease with cavitation
  • Previous allergic reactions

Side Effects

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  • Nausea, vomiting, diarrhoea, epigastric pain
  • Bleeding (usually limited to site of injection)
  • Hypotension, arrhythmias, tachycardia, bradycardia, heart failure, cardiogenic shock, pericarditis
  • Development of antistreptokinase antibodies
  • Anaphylaxis
  • Recurrent ischaemia
  • Pulmonary oedema
  • Headache
  • Musculoskeletal pain, chills, general weakness

Pregnancy

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  • Do not use

Breast-feeding

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  • Can be used

Storage

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  • Store below 25°C and do not freeze. Store reconstituted solution in a refrigerator at 2–8°C for only 24 hours.

⚠️ Caution

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  • Antibodies to streptokinase appear 4 days after use, and do not give streptokinase to the patient after this time
  • Use with caution in diabetic retinopathy, abdominal aneurysm and recent or concurrent anticoagulation therapy
  • Discontinue if bleeding is serious and treat as necessary
  • Can cause premature separation of placenta in first 18 weeks and possible foetal haemorrhage throughout pregnancy
  • In breast-feeding mothers, discard breast milk during the first 24 hours following thrombolytic therapy