streptokinase (Streptase, Kabikinase, Streptozyme)

Introduction

Tradename: Streptase, Kabikinase.

Also see streptozyme titer.

Indications

• Used to open obstructed coronary arteries in the early hours following myocardial infarction
• life threatening pulmonary embolism
• life threatening arterial thrombosis - clinical shock present
• recent severe or massive deep vein thrombosis
• occluded arteriovenous cannulas

Contraindications

• absolute
  • previous hemorrhagic stroke
  • intracranial neoplasm
  • active internal bleed
  • suspected aortic dissection
• 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

pregnancy category = c

safety in lactation = ?

Dosage

• 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).
• life threatening pulmonary embolus or arterial thrombosis:
  • 250,000 units IV over 30 minutes + 100,000 units/hour for 24 - 72 hours
• cannula occlusion:
  • 250,000 units into cannula
  • clamp for 2 hours
  • aspirate contents
  • flush with saline

Powder for injection: 250,000 units, 750,000 units, 1,500,000 units.

Adverse effects

• common (> 10%)
  • bronchospasm, periorbital swelling, angioneurotic edema, anaphylaxis, bleed at sites of percutaneous trauma, cardiac arrhythmias, hypotension
• uncommon (< 1%)
  • epistaxis, anemia, eye hemorrhage, rash, headache, nausea/vomiting, bronchospasm, chills, sweating
• other
  • bleeding
  • bruising
  • cerebral bleed
  • itching
  • flushing
  • allergic reaction
  • muscle pain
  • fever
  • reperfusion arrythmias

Mechanism of action

• promotes thrombolysis by activating plasminogen converting it to plasmin which hydrolyzes fibrin, fibrinogen, factor II, factor V, & factor VIII, complement & kallikrein
  • no fibrin specificity
• decrease erythrocyte aggregation
• altered platelet function

More general terms

• bacterial protein
• fibrinolytic agent (thrombolytic agent)
• enzymatic agent

Additional terms

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