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BLOOD AND BLOOD FORMING ORGANS › ANTITHROMBOTIC AGENTS › ANTITHROMBOTIC AGENTS › Enzymes
streptokinase
B01AD01
Forms & Strengths
- Powder for injection: 250,000 IU
- Powder for injection: 600,000 IU
- Powder for injection: 750,000 IU
- Powder for injection: 1,500,000 IU
Adult Dosing
- Acute myocardial infarction: 1,500,000 IU IV infusion over 60 minutes
- Acute pulmonary embolism: 250,000 IU loading dose over 30 minutes, then 100,000 IU/hour for 24-72 hours
- Deep vein thrombosis: 250,000 IU loading dose, then 100,000 IU/hour for 72 hours
- Occluded arteriovenous cannulae: 250,000 IU in 2 mL solution injected into cannula, wait 2 hours then aspirate
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been firmly established
- Thromboembolism (off-label): 1,000 to 4,000 IU/kg/hour IV infusion for 12-72 hours depending on occlusion site and severity
Indications
- Acute ST-elevation myocardial infarction (STEMI)
- Acute massive pulmonary embolism
- Deep vein thrombosis
- Arterial thrombosis or embolism
- Clearance of occluded arteriovenous cannulae
Mechanism of Action
- Binds to free and clot-bound plasminogen in a 1:1 stoichiometric complex to form an active enzymatic complex
- Catalyzes the conversion of inactive plasminogen to active plasmin
- Plasmin degrades fibrin clots, fibrinogen, and other plasma proteins, resulting in thrombolysis
Contraindications
- Active internal bleeding
- Recent history of cerebrovascular accident, intracranial surgery, or head trauma
- Severe uncontrolled hypertension
- Known hypersensitivity to streptokinase
- Recent major surgery, biopsy, or puncture of non-compressible vessels
- Recent gastrointestinal bleeding
Adverse Reactions
- Major and minor bleeding events
- Allergic reactions including urticaria, bronchospasm, and anaphylaxis
- Fever and chills during infusion
- Hypotension
- Reperfusion arrhythmias when treating myocardial infarction
Drug Interactions
- Anticoagulants (e.g., heparin, warfarin): increased risk of severe hemorrhage
- Antiplatelet agents (e.g., aspirin, clopidogrel, GPIIb/IIIa inhibitors): increased risk of bleeding
- Aminocaproic acid or other antifibrinolytics: antagonize the thrombolytic effect of streptokinase
Curated Content: Needs Vetting Before Put to Clinical Use