Haemorrhage streptokinase

Alteplase has proven effective in the early treatment of patients with acute myocardial infarction (i.e. those treated within 12 h after the first symptoms occur). Significantly increased rates of patient survival (as measured 1 day and 30 days after the initial event) are noted when tPA is administered in favour of streptokinase, a standard therapy (see later). tPA has thus established itself as a first-line option in the management of acute myocardial infarction. A therapeutic dose of 90-100 mg (often administered by infusion over 90 min) results in a steady-state alteplase concentration of 3-4 mg l 1 during that period. However, the product is cleared rapidly by the liver, displaying a serum half-life of approximately 3 min. As is the case for most thrombolytic agents, the most significant risk associated with tPA administration is the possible induction of severe haemorrhage. 

Fibrinolytic agents. Intravenous fibrinolysis has been assessed in at least six major international studies. Streptokinase has been abandoned (haemorrhage) while rt-PA is given in the 3-6 hour therapeutic window (secondary analysis disclosed significant results on the RANKIN scale at 3 months (NINDS) and at 3 months (ECASS II)). 

Q9 A patient who has recently received a head injury, or had surgery, or who has haemorrhaged recently may bleed excessively in this situation, thrombolytics are contraindicated. These drugs are also unsuitable for patients who have previously experienced an adverse reaction to one of the drugs, such as an allergic reaction to streptokinase. 

GLYCOPROTEIN lib/ Ilia INHIBITORS THROMBOLYTICS 1. t risk of major haemorrhage when co-administered with alteplase 2. Possible t risk of bleeding complications when streptokinase is co-administered with eptifibatide 1. Uncertain other thrombolytics do not seem to interact 2. Additive effect 1. Avoid co-administration 2. Watch for bleeding complications. Risk-benefit analysis is needed before co-administering this will involve the availability of alternative therapies such as primary angioplasty... 

Srivastava P, Godden DJ, Kerr KM, Legge JS. Fatal haemorrhage from aortic dissection following instillation of intrapleural streptokinase. Scott Med J 2000 45(3) 86-7. 

Patients with acute ischaemic stroke treated with streptokinase have an increased risk of early death due to cerebral haemorrhage if they are also given aspirin. 

A therapeutic regimen that usually controls haemorrhage involves discontinuation of enzyme treatment, administration of e-aminocaproic acid in a dose of 100 mg/kg body weight by slow intravenous injection, and blood transfusion (F). It is important to remember that the risk of thrombolytic therapy is not only haemorrhage but also thromboembolism. In one group of 93 patients with deep vein thrombosis treated by streptokinase infusion, a patient died of pulmonary embolism 8% of the patients in all experienced a less serious embolism (11 ). Eight cases of embolism, 4 of them with a fatal outcome, were seen in a series of 80 treated with streptokinase (18 ). 

Haemorrhage in the diseased hemisphere of the brain is a real danger in cerebro-thrombolytic treatment with urokinase, as with streptokinase. 

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