Makindo Medical Notes

Related Subjects: |Hypertension |Cardiac Thrombolysis |Stroke Thrombolysis |Alteplase |Tenecteplase |Streptokinase |Reteplase

⚠️ Initial hypotension can be managed with IV fluids, raising the foot of the bed, and slowing the infusion. Always balance benefits vs bleeding risk when using thrombolysis.

📖 About

Always check the BNF link here.

• 💉 Thrombolytic agent derived from Group A β-haemolytic streptococci.
• 🩸 Rate of major bleeding (requiring transfusion): ~0.3–0.5%.

⚡ Mechanism of Action

• 🔗 Converts plasminogen → plasmin (fibrinolytic enzyme).
• 🧩 Causes lysis of both clot and haemostatic fibrin.
• 🛑 Stimulates antibody formation → subsequent doses may be ineffective (avoid re-administration within 12 months).

🩺 Indications

• 🚑 STEMI – reduces mortality when given promptly.
• 🫁 Massive PE with haemodynamic compromise (specialist use).
• 🦵 Extensive proximal DVT with compromise (rare, specialist advice required).

💊 Dosing

💊 Dosing – Streptokinase

🔄 Interactions

• ⬆️ Bleeding risk with clopidogrel, warfarin, other anticoagulants.
• In STEMI, used alongside aspirin ± other antiplatelets (per protocol).
• ❌ Not recommended for ischaemic stroke thrombolysis (alteplase preferred).

⚠️ Cautions

• High risk of bleeding – only use where benefits outweigh risks.
• Antibody formation → avoid re-use within 12 months.

🚫 Contraindications

• 🔴 Active internal bleeding.
• 🧠 Recent (≤2 months) stroke, intracranial/spinal surgery, intracranial tumour, AVMs, aneurysms.
• 💉 Severe uncontrolled hypertension (>200/120 mmHg).
• ⚡ Recent major trauma, biopsy, or surgery (esp. head, spine, eye).
• Diabetic/proliferative retinopathy, bleeding disorders, anticoagulant therapy with high INR.
• Pregnancy, breast-feeding, allergy to streptokinase.

💥 Side Effects

• 🩸 Bleeding (most significant complication).
• 🌡️ Fever, chills, shivering (1–4%).
• 🤧 Allergic/anaphylactic reactions possible.
• ⬇️ Hypotension (1–10%) – usually not due to bleeding/anaphylaxis; manage with bed rest, IV fluids, slow infusion.
• 🟠 Rare: cholesterol embolism.

📊 Monitoring

• ⬇️ Plasminogen and fibrinogen levels during therapy.
• ⬆️ Prolonged TT, APTT, PT (normalise within 12–24h).
• Close haemodynamic + coagulation monitoring essential during infusion.

📑 References

• BNF: Streptokinase