Streptokinase

Adults: Acute evolving transmural MI: Administer as soon as possible after symptom onset. The greatest benefit in mortality reduction was observed when Streptokinase was administered within 4 hours, but statistically significant benefit has been reported up to 24 hours. For IV infusion, administer a total dose of 1500000 IU within 60 minutes. For intracoronary infusion, administer 20000 IU by bolus followed by 2000 IU per minute for 60 minutes, for a total dose of 140000 IU. PE, DVT, arterial thrombosis, or embolism: Institute treatment as soon as possible after the thrombotic event, preferably within 7 days. Any delay in starting lytic therapy in order to evaluate the effect of heparin therapy decreases the potential for optimal efficacy. Because human exposure to streptococci is common, antibodies to Streptokinase are prevalent, so a loading dose sufficient to neutralize these antibodies is required. A dose of 250000 IU Streptokinase infused into a peripheral vein over 30 minutes was found appropriate in over 90% of patients. If the thrombin time, or any other parameter of lysis, is not significantly different from the normal control level after 4 hours of therapy, Streptokinase should be discontinued, since this indicates excessive resistance. AV cannula occlusion: Before use, try to clear the cannula with the syringe technique using heparinized saline solution. If adequate flow is not re-established, Streptokinase may be used. Allow the effect of any pretreatment anticoagulants to diminish first. Slowly instill 250000 IU in 2 mL of solution into each occluded limb of the cannula, then clamp off the cannula limb(s) for 2 hours, observing closely for adverse effects. After treatment, aspirate the contents of the infused cannula limb(s), flush with saline, and reconnect the cannula. Pediatric use: Controlled clinical studies have not been conducted in children to establish safety and efficacy, so the evidence of clinical benefits and risks rests solely on anecdotal reports in patients ranging in age from under 1 month to 16 years. The largest number of reports concerns the use of Streptokinase in arterial occlusions. For arterial occlusions, the most frequently used loading dose was 1000 IU/kg, with fewer patients receiving 3000 IU/kg; loading dose durations have typically ranged from 5 to 30 minutes. Continuous infusion doses were frequently 1000 IU/kg/h, with fewer at 1500 IU/kg/h, and infusions were maintained for 12 hours or less in roughly half of the published cases, with a smaller proportion running between 12 and 24 hours. Reported adverse events in the pediatric population are similar in nature to those seen in adults. Rates of all bleeding complications have been variable, reaching as high as 50% at catheter sites in some studies, and bleeding has occasionally required transfusion, so careful monitoring of patient status is necessary.