II. Background

  1. Isolated from Group C Beta-hemolytic Streptococcus

IV. 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

V. 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

VI. Dosing

  1. Streptokinase 1.5 million units over 60 minutes
  2. Premedication
    1. Hydrocortisone 100 mg IV
    2. Diphenhydramine 25 mg IV

VII. Adverse Effects

  1. See Thrombolytic
  2. Major Bleeding (e.g. Intracranial Hemorrhage)
  3. Severe Allergic Reaction

VIII. Pharmacokinetics

  1. Half-Life: 83 minutes
    1. Reduced to 12 min in patients with antibodies to Streptokinase from prior streptococcal infection

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