Pharm

Streptokinase

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Streptokinase

  • See Also
  1. Thrombolytic
  • Background
  1. Isolated from Group C Beta-hemolytic Streptococcus
  • Indications
  1. Replaced by Recombinant Tissue Plasminogen Activator (r-tPA)
  2. Historical Uses
    1. ST Elevation Myocardial Infarction (STEMI
    2. Pulmonary Embolism
    3. Hemodialysis shunt thrombosis
  • Contraindications
  1. Conditions in which streptococcal Antibody is more likely to be present (risk of severe Allergic Reaction)
    1. Prior exposure to Streptokinase
    2. Recent streptococcal infection
  • Mechanism
  1. Activates plasminogen to plasmin
    1. Unlike tPA, does not bind Fibrin first before activating plasminogen (not clot specific)
  2. Plasmin breaks down both Fibrin and Fibrinogen to Fibrin
    1. Fibrin Degradation Products result, which in turn also act to inhibit Fibrin formation
  3. Benefits
    1. Lasts longer than T-PA (duration 24 hours)
    2. Less bleeding risk
      1. Probably less risk than T-PA in over age 75
  • Dosing
  1. Streptokinase 1.5 million units over 60 minutes
  2. Premedication
    1. Hydrocortisone 100 mg IV
    2. Diphenhydramine 25 mg IV
  • Adverse Effects
  1. See Thrombolytic
  2. Major Bleeding (e.g. Intracranial Hemorrhage)
  3. Severe Allergic Reaction
  • Pharmacokinetics
  1. Half-Life: 83 minutes
    1. Reduced to 12 min in patients with antibodies to Streptokinase from prior streptococcal infection