⚠️ 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

Indication	Details
❤️ STEMI	Streptokinase • 1,500,000 IU IV over 60 min in 100 mL 0.9% saline • Single dose
💨 Massive PE (with compromise)	Streptokinase • 250,000 IU IV over 30 min, then 100,000 IU/hr for 24 h • Continuous infusion (specialist use)
🦵 Large DVT (rare use)	Streptokinase • 250,000 IU IV over 30 min, then 100,000 IU/hr for 72 h • Continuous infusion (specialist use)

🔄 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

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Streptokinase 💊