Streptokinase Dosing for Cardiovascular Emergencies

For acute myocardial infarction, streptokinase should be administered as 1.5 million units intravenously over 30-60 minutes. 1

Dosing by Indication

Recommended dose: 1.5 million units administered intravenously over 30-60 minutes 1
Streptokinase should be considered when primary PCI cannot be performed by an experienced team within 120 minutes of first medical contact 1
Administration may be associated with hypotension, but severe allergic reactions are rare 1
Re-administration of streptokinase should be avoided due to antibodies that can impair its activity and increase risk of allergic reactions 1

The recommended dose is 1.5 million units administered intravenously over one hour 2
This regimen has been shown to reverse acute pulmonary arterial hypertension and improve pulmonary perfusion without increasing hemorrhagic complications 2

Streptokinase is NOT recommended for acute ischemic stroke due to increased mortality primarily from hemorrhagic transformation of ischemic cerebral infarcts 3
Studies have shown that 1.5 million units over one hour resulted in significantly higher mortality at 10 days (34.0% vs. 18.2%) compared to placebo 3

Aspirin should be administered with streptokinase (150-500 mg orally or 250 mg IV if oral ingestion is not possible) 1
Clopidogrel should be added to aspirin (loading dose of 300 mg orally if aged ≤75 years, followed by maintenance dose of 75 mg/day) 1
The benefits of aspirin and streptokinase are additive 1

Anticoagulation is recommended until revascularization (if performed) or for the duration of hospital stay up to 8 days 1
Options include:
- Unfractionated heparin: 60 U/kg IV bolus (maximum 4000 U) followed by IV infusion of 12 U/kg/hr (maximum 1000 U/hr) for 24-48 hours, targeting aPTT 50-70 seconds or 1.5-2.0 times control 1
- Enoxaparin: For patients <75 years, 30 mg IV bolus followed by 1 mg/kg SC every 12 hours; for patients >75 years, no IV bolus with first SC dose of 0.75 mg/kg 1
- Fondaparinux: 2.5 mg IV bolus followed by 2.5 mg SC once daily (preferred with streptokinase) 1

Monitor for reperfusion: relief of symptoms, maintenance of hemodynamic/electrical stability, and reduction of ST-segment elevation by at least 50% at 60-90 minutes 1
Transfer to a PCI-capable center following fibrinolysis is indicated in all patients 1
Angiography with a view to revascularization is recommended after successful fibrinolysis, optimally between 3-24 hours 1
Monitor for bleeding complications, which occur in 4-13% of patients 1
Watch for hypotension, which commonly occurs with streptokinase administration 1

Streptokinase should not be re-administered due to antibody formation 1
Intracranial hemorrhage occurs in 0.9-1.0% of patients 1
Risk factors for intracranial hemorrhage include lower weight, female sex, previous cerebrovascular disease, and systolic/diastolic hypertension on admission 1
Fibrin-specific agents (tenecteplase, alteplase, reteplase) are generally preferred over streptokinase due to better safety profile 1

Accelerated streptokinase administration (1.5 million units over 20 minutes) has been associated with higher rates of coronary reperfusion (80%) compared to standard protocol over 60 minutes (58%) 4
However, fibrin-specific agents are generally preferred over streptokinase due to reduced risk of non-cerebral bleeding and blood transfusion 1