Streptokinase Aspirin

Randomised controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischaemic stroke. Multicentre Acute Stroke Trial-Italy (MAST-I)... 

In a more extensive international trial, 17,187 patients were treated intravenously with streptokinase alone, aspirin alone, a combination of streptokinase and aspirin, or placebo (78). Streptokinase and aspirin were equally effective in treating acute myocardial infarction, each decreasing mortahty by 25% their combination further reduced mortahty by 42%. A significant reduction in mortahty was seen even in those patients treated up to 24 hours after the onset of symptoms. 

One drawback of thrombolytic therapy is a high incidence of reocclusion. In a report using a canine model, inclusion of heparin [9005-49-6] (anticoagulant therapy) in the treatment prevented this side effect (158). The combination of aspirin [50-78-2] (antiplatelet therapy) and streptokinase (thrombolytic therapy) has also shown significant therapeutic advantages (78). Although additional work is needed to estabUsh the thrombolytic advantage of various combinations, preliminary results in this area indicate promise in terms of increased efficacy and reduced side effects. 

In the Multicenter Acute Stroke Trial Italy (MAST-I) study, 622 patients were randomized in a 2 X 2 factorial design to receive either a 1-hour infusion of 1.5 lU streptokinase or 300 mg aspirin or both, or neither. Streptokinase (alone or with aspirin) was associated with a greater number of fatahties at 10 days (OR 2.7,95% Cl 1.7. 3). In MAST-I, neither aspirin monotherapy nor combination therapy reduced the primary outcome of combined 6-month fatahty and severe disability. 

Combination GP Ilb/IIIa and rt-PA Therapy for Acute Stroke The combination of antiplatelet and thrombolytic drugs has proven efficacy in the setting of myocardial ischemia where an additive effect is seen. In acute stroke thrombolysis with a very narrow time window and less than 50% optimal reperfusion rates,adjunctive therapy with antiplatelets may be a promising approach. However, MAST-I concluded that the group of patients receiving streptokinase plus aspirin had a marked increase in 10-day mortality. 

ISIS-3. ISIS-3 a randomised comparison of streptokinase vs tissue plasminogen activator vs anistreplase and of aspirin plus heparin vs aspirin alone among 41299 cases of suspected acute myocardial infarction. Lancet 1992 339 753-70. 

ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction ISIS-2. Lancet 1988 2 349-360. 

Normal hemostasis is a balance between excessive and inadequate blood clotting. Overactive blood clotting is harmful because of the tendency for thrombus formation and occlusion of arteries and veins. Vessels may become directly blocked by the thrombus, or a portion of the thrombus may break off and create an embolism that lodges elsewhere in the vascular system. The tendency for excessive thrombus formation in the venous system is usually treated with anticoagulant drugs such as heparin and warfarin. Platelet inhibitors such as aspirin help prevent arterial thrombogenesis. Thrombolytic drugs (streptokinase, t-PA) that facilitate the dissolution of harmful clots may successfully reopen... 

Clinical trials One of the trials (ISIS-3) showed that streptokinase plus aspirin performed as well as recombinant tissue-type plasminogen activator (rt-PA) or complex formulations of streptokinase such as anistreplase (APSAC). The GUSTO trial showed a small advantage for the much more expensive t-PA over streptokinase, but with a significantly higher risk of hemorrhagic stroke. Nine clinical trials—each containing over 1000 patients with suspected acute myocardial infarction—... 

White HD, Aylward PE, Frey MJ, et al. Randomized, doubleblind comparison of Hirulog versus heparin in patients receiving streptokinase and aspirin for acute myocardial infarction (HERO). Circulation I 997 96 21 55-2161. 

Acute myocardial infarction (MI) Fibrinolytic therapy Streptokinase Alteplase Reteplase Heparin Aspirin Reduced coronary and all-cause mortality GISSI-1 ISIS-2 GISSI-2/ISG ISIS-3 GUSTO >120,000 10... 

Once the heart has stopped fibrillating, the patient is given oxygen via a mask and blood is taken for cell counts, glucose, lipids and cardiac enzymes. Diamorphine (for pain relief) and aspirin are given and, if there are no contraindications, thrombolysis can be started using either streptokinase or tissue plasminogen activator. 

ASPIRIN THROMBOLYTICS t risk of intracerebral bleeding when streptokinase is co-administered with higher dose (300 mg) aspirin Additive effect Avoid co-ingestion when streptokinase is given for cerebral infarction use low-dose aspirin when co-administered for myocardial infarction... 

Ciccone A, Motto C, Aritzu E, Piana A, Candelise L. Negative interaction of aspirin and streptokinase in acute ischemic stroke further analysis of the Multicenter Acute Stroke Trial—Italy. Cerebrovasc Dis 2000 10(l) 61-4. 

The combination of thrombolytic agents with an anticoagulant and/or aspirin has been said to be life-threatening. An excess of major bleeding episodes with combined subcutaneous heparin and streptokinase or alteplase treatments (1.0% with heparin versus 0.5% without heparin) has been reported in the International Study Group Trial (103) in patients with suspected acute myocardial infarction. 

In the PARADIGM II trial, lamifiban is being studied using three dosage regimens in combination with tPA, aspirin and heparin or with streptokinase and aspirin [127,168], Full results are yet to appear. 

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