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streptokinase (Streptase, Kabikinase, Streptozyme)

Tradename: Streptase, Kabikinase. Also see streptozyme titer. Indications: 1) Used to open obstructed coronary arteries in the early hours following myocardial infarction 2) life threatening pulmonary embolism 3) life threatening arterial thrombosis - clinical shock present 4) recent severe or massive deep vein thrombosis 5) occluded arteriovenous cannulas Contraindications: 1) absolute - previous hemorrhagic stroke - intracranial neoplasm - active internal bleed - suspected aortic dissection 2) relative - blood pressure > 180/110 - currently on anticoagulants - recent trauma - active peptic ulcer disease - streptococcal protein exposure within past year - major surgery within the last 10 days - intracranial or intraspinal surgery Dosage: 1) acute myocardial infarction: - 1.5 million units IV over 30-60 minutes (no bolus) - no added benefit & potential harm in adding heparin to streptokinase (excluding 5000 mg SQ BID DVT prophylaxis). 2) life threatening pulmonary embolus or arterial thrombosis: - 250,000 units IV over 30 minutes + 100,000 units/hour for 24 - 72 hours 3) cannula occlusion: a) 250,000 units into cannula b) clamp for 2 hours c) aspirate contents d) flush with saline Powder for injection: 250,000 units, 750,000 units, 1,500,000 units. Adverse effects: 1) common (> 10%) - bronchospasm, periorbital swelling, angioneurotic edema, anaphylaxis, bleed at sites of percutaneous trauma, cardiac arrhythmias, hypotension 2) uncommon (< 1%) - epistaxis, anemia, eye hemorrhage, rash, headache, nausea/vomiting, bronchospasm, chills, sweating 3) other - bleeding - bruising - cerebral bleed - itching - flushing - allergic reaction - muscle pain - fever - reperfusion arrythmias Mechanism of action: 1) promotes thrombolysis by activating plasminogen converting it to plasmin which hydrolyzes fibrin, fibrinogen, factor II, factor V, & factor VIII, complement & kallikrein - no fibrin specificity [2] 2) decrease erythrocyte aggregation 3) altered platelet function

Related

Streptococcus pyogenes enzyme Ab in serum (Streptozyme titer) thrombolytic therapy

Specific

Streptokinase Parenteral

General

bacterial protein enzymatic agent fibrinolytic agent (thrombolytic agent)

Properties

MISC-INFO: elimination route LIVER lifetime 18 MINUTES {INITIAL_1/2LIFE} pregnancy-category C safety in lactation ?

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2015
  3. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  4. Kaiser Permanente Northern California Regional Drug Formulary, 1998