Fever streptokinase

The mortahty is usually reduced from 12% in the control group to 9—10% in the streptokinase group. Side effects are bleeding and hemorrhage, fever, and in rare occasions, anaphylaxis. 

The nurse must continually assess the patient for anaphylactic reactions (difficulty breathing, wheezing, fever, swelling around the eyes, hives, or itching) particularly with anistreplase or streptokinase Resuscitation equipment is immediately available... 

The major toxicity of all thrombolytic agents is hemorrhage. Streptokinase can cause allergic reactions with fever, rash and, although rarely, anaphylaxis. 

Streptokinase is regularly reported to have induced an immune complex syndrome, characterized by plasmacy-tosis, often severe, and accompanied by fever and the development of hemolytic anemia, occurring as early as the first week after the start of treatment in some cases, temporary alterations in renal function also occur (63). 

Because it is a foreign protein, streptokinase is associated with significant hypersensitivity reactions. Most people have, at some point in their lives, had a streptococcal infection and, therefore, have developed circulating antistreptococcal antibodies. These antibodies frequently are active against streptokinase as well. The response of the streptokinase to these antibodies can vary widely, from inactivation of the fibrinolytic properties of the protein to rash, fever, and rarely, anaphylaxis. Significant allergic reactions to streptokinase occur in approximately 3% of patients. 

The interaction that results in neutralisation of the thrombolytics is established and clinically important. One author says that clinically, therapy is not repeated within a year as it would not work. Given that it has been suggested that the effects may be very persistent, it would seem prudent, if a second use is needed, to use a thrombolytic with less antigenic effects such as alteplase. The British National Formulary says that streptokinase should not be used again beyond 4 days of the first use of either streptokinase or anistreplase. In addition, the manufacturer recommends avoidance of streptokinase in patients who have had recent streptococcal infections that have produced high anti-streptokinase titres, such as acute rheumatic fever or acute glomerulonephritis. ... 

Apart from blood coagulation disorders, the main complication of streptokinase, this enzyme can produce reactions suggestive of aUeigic manifestations such as fever, hypotension and flushing (2 ), as well as rashes and arthralgia (9 ). Attainment of a high plasma titre of streptococcal antibodies during the infusion renders further treatment impossible for at least 6 months ( ). 

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