From the Guidelines
Streptokinase is typically administered as a 1.5 million unit intravenous infusion over 30-60 minutes for acute myocardial infarction (heart attack). The dose of streptokinase can vary depending on the specific condition being treated, but for acute myocardial infarction, the recommended dose is 1.5 million units IV given over 30-60 minutes 1, 2.
Key Considerations
- Before administration, patients should be screened for contraindications including active bleeding, recent surgery, stroke, or previous streptokinase exposure within 6 months.
- Concurrent heparin and aspirin are often given, with heparin typically started after the streptokinase infusion is complete.
- Blood pressure, heart rate, and signs of bleeding should be monitored closely during administration.
- Streptokinase works by activating plasminogen to form plasmin, which breaks down fibrin clots.
- It is antigenic, meaning patients can develop antibodies against it, limiting its repeated use.
- Common side effects include bleeding, hypotension, and allergic reactions, which should be promptly addressed if they occur.
Monitoring and Adjustments
- The patient's condition should be closely monitored during and after administration of streptokinase, with adjustments made as needed to minimize the risk of complications.
- The use of streptokinase should be guided by the most recent and highest quality evidence, with consideration given to the patient's individual needs and medical history 3, 4.
- In cases where streptokinase is not effective or is contraindicated, alternative fibrinolytic agents may be considered, such as alteplase or tenecteplase 5.
From the FDA Drug Label
The four treatment regimens included accelerated infusion of Activase (≤100 mg over 90 minutes) plus intravenous (IV) heparin (n = 10,396); Streptokinase (1. 5 million units over 60 minutes) plus IV heparin (SK [IV], n =10,410); The dose of streptokinase is 1.5 million units administered over 60 minutes 6.
From the Research
Dose of Streptokinase
The dose of streptokinase, a fibrinolytic agent, varies depending on the condition being treated.
- For patients with pulmonary embolism, a dose of 1,500,000 IU in one-hour streptokinase infusion has been used 7.
- For acute myocardial infarction, the usual dosage is 1.5 million units given over 1 hour 8.
- Low doses of streptokinase, ranging from 500,000 to 750,000 units, have also been used in patients with ST elevation acute myocardial infarction 9.
- A fixed dosage schedule of a loading dose of 250,000 units followed by a maintenance infusion of 100,000 units per hour for 24 to 72 hours has been used for streptokinase in patients with acute pulmonary embolism 10.
- A dose of 2,500,000 IU of streptokinase over 24 hours has been used in a multicentre trial of streptokinase in acute myocardial infarction 11.
Administration Schedule
The administration schedule of streptokinase also varies.
- It can be given as a one-hour infusion 7, 8.
- It can be administered in no more than 30 minutes, with heparin, within 0 to 6 hours of symptom onset 9.
- It can be given as a loading dose followed by a maintenance infusion for 24 to 72 hours 10.
- It can be given as an infusion over 24 hours 11.
Efficacy and Safety
The efficacy and safety of streptokinase have been evaluated in several studies.
- High dose and short-term streptokinase infusion has been shown to improve survival among patients with pulmonary embolism and cardiogenic shock, without increasing hemorrhagic complications 7.
- Low doses of streptokinase have been found to be at least as effective as classical therapy in the treatment of ST elevation acute myocardial infarction 9.
- Thrombolytic treatment with streptokinase has been shown to reduce in-hospital mortality in massive pulmonary embolism, with a trend towards reduced mortality 10.
- However, streptokinase has also been associated with hemorrhagic complications, including minor and serious bleeding 8, 11.