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Streptokinase

Pronunciation: STREP-toe-KIN-ace
Class: Thrombolytic enzyme
Trade Names:
Streptase
- Powder for Injection 250,000 units
- Powder for Injection 750,000 units
- Powder for Injection 1,500,000 units

Pharmacology
Converts plasminogen to the enzyme plasmin, which aids in dissolution of blood clots.

Pharmacokinetics
Metabolism
No metabolites identified.

Elimination
Streptokinase is cleared by the liver. The t is approximately 23 min (for activator complex).

Indications and Usage


Acute MI, lysis of intracoronary thrombi, improvement of ventricular function, and reduction of mortality
associated with acute MI (IV or intracoronary route); reduction of infarct size and CHF associated with
acute MI (IV); lysis of objectively diagnosed (eg, angiography) pulmonary emboli (involving obstruction
of blood flow to a lobe or multiple segments, with or without unstable hemodynamics); lysis of
objectively diagnosed (eg, ascending venography), acute, extensive thrombi of the deep veins (eg, those
involving the popliteal vessels); lysis of acute arterial thrombi and emboli; alternative to surgical revision
for clearing totally or partially occluded arteriovenous cannulae when acceptable flow cannot be
achieved.

Contraindications
Active internal bleeding; recent cerebrovascular accident (within 2 mo); intracranial or intraspinal
surgery; intracranial neoplasm; severe uncontrolled hypertension.

Dosage and Administration


Acute Evolving Transmural MI
Adults
IV infusion Administer as soon as possible after symptom onset (greatest benefit when administered
within 4 h, but benefit has been reported up to 24 h). Infuse a total dose of 1,500,000 units within 60 min.
Intracoronary infusion Administer 20,000 units by bolus followed by 2000 units/min for 60 min (total
dose, 140,000 units).
Pulmonary Embolism, Deep Vein Thrombosis (DVT), Arterial Thrombosis, or Embolism
Adults
IV infusion Administer as soon as possible after onset of thrombolic event, preferably within 7 days. A
loading dose of 250,000 units infused into a peripheral vein over 30 minutes has been found appropriate
in over 90% of patients. If thrombin time or any parameter of lysis after 4 h of therapy is not significantly
different from the normal control level, discontinue streptokinase because excessive resistance is present.
Dose and duration of therapy (following the loading dose of 250,000 units/30 min): pulmonary embolism
100,000 units/h for 24 h (72 h if concurrent DVT is suspected); DVT 100,000 units/h for 72 h; arterial
thrombosis or embolism 100,000 units/h for 24 to 72 h.
Arteriovenous Cannulae Occlusion

Slowly instill 250,000 in 2 mL of solution into each occluded limb of the cannula. Clamp off cannula
limb(s) for 2 h. Closely observe patient for adverse effects. After treatment, aspirate contents of infused
cannula limb(s) and flush with saline before reconnecting cannula.

Storage/Stability
Store unopened vials at controlled room temperature (59 to 86F). Use reconstituted solution
immediately or within 8 h if stored at 36 to 46F. Discard any unused solution.

Drug Interactions
Anticoagulants, agents that alter platelet function (eg, aspirin, other NSAIDs, dipyridamole), other
thrombolytic agents, agents that alter coagulation
May increase the risk of bleeding.

Incompatibility
Do not add other medication to the streptokinase container.

Laboratory Test Interactions


Will cause marked decreases in plasminogen and fibrinogen levels and increases in thrombin time,
activated partial thromboplastin time, and prothrombin time, which usually normalize within 12 to 24 h.

Adverse Reactions
Cardiovascular
Hypotension (sometimes severe).

Hematologic
Bleeding (major and minor).

Respiratory
Respiratory depression.

Miscellaneous
Allergic reactions (eg, fever and shivering, urticaria, itching, flushing, nausea, headache, musculoskeletal
pain); anaphylactic and anaphylactoid reactions (ranging from minor breathing difficulty to
bronchospasm, periorbital swelling or angioneurotic edema); transient elevations of serum transaminases;
back pain.