What It Is and What It Treats
Streptokinase is a thrombolytic agent derived from
beta-haemolytic Streptococci. It binds to plasminogen to form a complex that
activates free plasminogen to plasmin, a protease that degrades fibrin clot.
This systemic fibrinolysis can open occluded blood vessels and restore
perfusion.
Indications (hospital use only):
• Acute ST-elevation myocardial
infarction (STEMI) — when primary percutaneous coronary intervention (PCI) is
not available within the required timeframe (ideally within 12 hours of symptom
onset)
• Massive or life-threatening pulmonary
embolism (PE)
• Deep vein thrombosis (DVT) — selected
cases with limb-threatening venous occlusion
• Arterial thrombosis or embolism —
selected acute cases
• Central venous catheter occlusion
(lower doses)
Dosing and Administration
Acute STEMI:
1,500,000 IU as a slow IV infusion over 30–60 minutes,
diluted in 100mL of 0.9% NaCl or 5% dextrose.
Massive PE:
250,000 IU loading dose over 30 minutes, then 100,000
IU/hour for 24 hours.
Reconstitution: add diluent gently, swirl to dissolve — do
NOT shake (foaming reduces potency). Administer via IV infusion only.
Continuous monitoring of vital signs, coagulation parameters (fibrinogen,
aPTT), and ECG throughout infusion. Resuscitation equipment, adrenaline,
hydrocortisone, and chlorphenamine must be at the bedside before infusion
starts.
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🚨 |
SEEK URGENT ATTENTION: DO NOT RE-ADMINISTER within 12 months of a
previous streptokinase dose. Anti-streptokinase antibodies persist and cause
both treatment failure and anaphylaxis. Use an alternative thrombolytic
(alteplase or tenecteplase) in patients with prior streptokinase exposure
within 12 months. |
Side Effects
|
Frequency |
Side Effects |
|
Very Common |
Bleeding at puncture/catheter sites,
superficial bruising, minor mucosal bleeding |
|
Common |
Fever, chills, allergic reactions (urticaria,
flushing), hypotension during infusion (manage by slowing or pausing the
infusion) |
|
Serious — Seek Urgent Help |
Intracranial haemorrhage (most feared
complication): sudden severe headache, facial drooping, unilateral weakness,
or speech difficulty — STOP infusion immediately, urgent neurology/ICU
review. Anaphylaxis. Reperfusion arrhythmias post-STEMI thrombolysis (managed
by cardiac monitoring and standard ACLS protocols). |
Absolute Contraindications
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⚠ |
CAUTION:
Any
one of the following is an absolute contraindication: active internal
bleeding (other than menstruation), intracranial surgery or head trauma
within 3 months, prior stroke (ischaemic or haemorrhagic at any time), known
intracranial neoplasm or AVM, suspected aortic dissection, uncontrolled
hypertension (>180/110 mmHg despite treatment), significant closed-head or
facial trauma within 3 months. |
Additional contraindications: prior streptokinase within 12
months, known hypersensitivity, active peptic ulcer, major surgery within 3
weeks, prolonged CPR.
Key Drug Interactions
• Heparin, warfarin, DOACs,
antiplatelet agents: additive bleeding risk — co-administration requires
careful risk-benefit assessment and is managed on a case-by-case basis by the
clinical team
• Antifibrinolytic agents (tranexamic
acid, aminocaproic acid): directly antagonise streptokinase — do not
co-administer
Clinical Notes
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🩺 |
PRESCRIBER NOTE: Pre-treatment
checklist: confirm STEMI diagnosis (ECG, clinical presentation), time of
onset <12 hours, rule out all contraindications (BP, recent surgery, prior
stroke, prior streptokinase), obtain IV access and baseline coag/FBC/U&E.
Post-thrombolysis: transfer to PCI-capable centre (pharmacoinvasive strategy)
within 3–24 hours. Monitor for successful reperfusion signs (ST-segment
resolution >50%, reperfusion arrhythmias, pain resolution). |
Frequently Asked Questions
Q: What is streptokinase used for?
Streptokinase is a
clot-dissolving agent used in hospital emergencies — most commonly to reopen a
blocked coronary artery during a heart attack (STEMI), or to treat a massive
blood clot in the lungs (pulmonary embolism).
Q: Can streptokinase be given again if I have had it
before?
No — not within 12
months. After a dose of streptokinase, the body produces antibodies against it.
Within 12 months, these antibodies will neutralise a repeat dose and can cause
a severe allergic reaction. An alternative thrombolytic (alteplase or tenecteplase)
would be used instead. Always tell your medical team if you have had
streptokinase before.
Q: What is the biggest risk of this treatment?
The most serious risk
is intracranial haemorrhage (bleeding into the brain), which can cause stroke
or death. This is why all patients are carefully screened for contraindications
before treatment — the benefit (opening a blocked coronary or pulmonary artery)
must clearly outweigh this risk.
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