Streptokinase

What it is and how it works

Streptokinase is a protein produced by group C beta-haemolytic streptococci that forms a complex with plasminogen; this complex converts other plasminogen molecules to plasmin, which degrades fibrin and dissolves thrombi. It is not fibrin-specific and causes systemic fibrinogen depletion.

Indications

Acute myocardial infarction within 12 hours of symptom onset; deep vein thrombosis, pulmonary embolism, acute arterial thromboembolism and thrombosed arteriovenous shunts.

Dosage and administration (summary)

For acute myocardial infarction, 1.5 million IU by intravenous infusion over 60 minutes; other indications use a loading dose followed by a maintenance infusion according to protocol.

Contraindications

Recent or active bleeding, history of haemorrhagic stroke, recent ischaemic stroke, recent major surgery or trauma, intracranial neoplasm, severe uncontrolled hypertension, aortic dissection, bleeding diathesis, and previous streptokinase treatment more than 5 days earlier (antibodies reduce efficacy and increase allergy risk).

Warnings and precautions

Bleeding, including intracranial haemorrhage, is the main hazard. Allergic reactions, fever and hypotension (often infusion-rate related) are common; antibodies develop after exposure, so it should not be re-administered after 5 days from a previous dose or recent streptococcal infection.

Pregnancy

Use in pregnancy only for life-threatening thrombosis when benefit outweighs the risk of bleeding, particularly in the first 18 weeks.

Storage and supply

Store below 25 °C; use the reconstituted solution promptly.

Source: reference summary prepared from the EU SmPC/EPAR, BNF and WHO Model Formulary. The approved product information in Iran governs.