Streptokinase

How it works

It forms a complex with plasminogen that activates conversion of plasminogen to plasmin, which degrades fibrin and breaks down thrombus.

Prescribing in practice

• It carries a major risk of serious haemorrhage and is contraindicated in active bleeding, recent haemorrhagic stroke and other conditions predisposing to bleeding.
• Because antibodies develop, repeat administration between several days and a long period after a previous dose, or after streptococcal infection, may be ineffective and increase the risk of allergic reactions.
• Anaphylactoid reactions and hypotension can occur during infusion.

Monitoring

Monitor for bleeding, blood pressure and signs of allergic reaction during and after administration.

Counselling the patient

• Report any bleeding, severe headache or signs of an allergic reaction promptly.
• Tell future healthcare staff that you have received this medicine, as it may not be suitable again.
• Bruising and minor bleeding at puncture sites can occur.

Evidence & guidelines

The GISSI and ISIS-2 trials established the mortality benefit of streptokinase thrombolysis in acute myocardial infarction, though primary PCI is now preferred where available.