Streptokinase administration

For streptokinase administration, previous streptokinase use (greater than 5 days) or prior allergic reactions... 

Recent (within 2 weeks) internal bleeding For prior streptokinase administration, prior administration (5 days-2 years), or prior allergic reactions Pregnancy Active peptic ulcer... 

Laisaar T, Pullerits T. Effect of intrapleural streptokinase administration on antistreptokinase antibody level in patients with loculated pleural effusions. Chest (2003) 123, 432-5. 

Donnan GA, Davis SM, Chambers BR, Gates PC, Hankey GJ, McNeil JJ, Rosen D, Stewart-Wynne EG, Tuck RR. Streptokinase for acute ischemic stroke with relationship to time of administration Australian Streptokinase (ASK) trial study group. JAMA. 1996 276 961-966. 

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. 

As a bacterial protein, streptokinase is viewed by the human immune system as an antigenic substance. In some cases, its administration has elicited allergic responses that have ranged from mild rashes to more serious anaphylactic shock (an extreme and generalized allergic response characterized by swelling, constriction of the bronchioles, circulatory collapse and heart failure). 

The need for a rapid onset of action (and/or clearance) usually requires that an IV route be used, although at a certain stage of cardiopulmonary resuscitation (for example), the need for an even more rapid effect may require the use of an intracardiac injection. The required site of action may influence the choice of route of administration (e.g., certain radiopaque dyes are given intraarterially near the site being evaluated streptokinase is sometimes injected experimentally into the... 

Intracranial bleeding Following concomitant thrombolytic therapy with alteplase (tPA) or streptokinase may be life-threatening. Carefully assess the risk of lepirudin administration vs its anticipated benefit in patients with increased risk of bleeding. In particular, this includes the following conditions ... 

Patients who have had a heart attack or stroke are frequently treated by intravenous administration of tissue plasminogen activator (tPA) or streptokinase, enzymes that break down fibrin clots that clog blood vessels. 

F. Role in therapy Reteplase is a novel thrombolytic agent. It has a longer half-life than alteplase, which allows bolus administration. Its administration technique is much simpler than that of alteplase. In addition reteplase has achieved more rapid, complete, and sustained thrombolysis of the infarct-related artery compared to standard doses of alteplase with comparable safety. Reteplase is at least as effective as streptokinase and alteplase in AMI. 

E Role in therapy Thrombolytic agents currently licensed for the treatment of AMI in the United States include streptokinase, tissue plasminogen activator, anistreplase, reteplase, and tenecteplase. TNKase and alteplase have similar clinical efficacy for thrombolysis after myocardial infarction (i.e., similar mortality and intracranial hemorrhage rates). However, advantages of TNKase include ease and rapidity of administration, longer half-life, greater fibrin specificity, and lower noncerebral bleeding rates. Reteplase shares some characteristics of tenecteplase (e.g., similar half-life, rapid onset, and ease of administration). 

At present, the binary water-soluble preparation of heparin and proteolytic enzymes is being applied for the treatment of thromboses. For instance, injection into the bloodstream of heparin-plasmin complex or a heparin-plasmin-streptokinase preparation leads to the total dissolution of the thrombus, while if introduced separately, heparin and streptokinase do not display the lytic action at all, and plasmin, alone or together with streptokinase, dissolves the thrombus only partially 132>. The treatment of acute thrombophlebitis with trypsin resulted in a full dissolution of the thrombus and in an increase of antithrombin III in the blood 133). Administration of trypsin together with heparin has an effect similar in efficiency to the action of the heparin-plasmin complex 134>. The use of a mix of heparin and urokinase for improving tbrom-boresistance of polymeric materials was also described 13S). These substances were immobilized by preliminary coating of the surface of a polymer with a graphite layer and subsequent adsorption of heparin and the enzyme. 

In addition to the intravenous route, streptokinase is also administered by the direct intracoronary route. In a Dutch study with 533 patients treated intracoronarily, a significant reduction (12%) in mortality was noted (79). Of the two methods of administration, the intravenous route appears to be the method of choice because of ease of administration and the shorter lag period before therapy is initiated the lag period observed in studies utilizing the intracoronary route is attributable to the time required for catheterization. 

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... 

Streptokinase is a protein derived from p-haemolytic streptococci it forms a complex with plasminogen (bound loosely to fibrin) where it converts plasminogen to plasmin. Too rapid administration causes abrupt fall in blood pressure. The is 20 min. 

Anistreplase, a compound consisting of streptokinase and anisoylated plasminogen, can also cause allergic reactions, but has a longer half-life, allowing intravenous administration in a relatively short interval of time. 

Godley PJ, Bell RC. Major hemorrhage following administration of intrapleural streptokinase. Chest 1984 86(3) 486-7. 

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