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