Streptokinase is indicated in Myocardial infarction.

Myocardial Infarction

• Systemic administration: A single dose of 1.5 million IU streptokinase should be infused intravenously over one hour.
• Local intracoronary administration: A bolus of 20,000 IU streptokinase should be followed by a maintenance infusion of 2,000 IU to 4,000 IU per minute over 30 to 90 minutes depending on the achievement of coronary artery patency.

 Side effects associated with streptokinase are as folows-

• rash
• flushing
• itching
• urticaria
• hypotension
• arrhythmia
• angioneurotic oedema
• dyspnea (shortness of breath)
• bronchospasm
• hypotension
• arthritis
• vasculitis

Rash	Flushing	Urticaria
Hypotension	Arrhythmia	Shortness of Breath

• The following conditions are normally considered contraindications to streptokinase therapy, but in some cases, the benefits may outweigh the risks-
  • recent severe gastrointestinal bleeding, e.g. active peptic ulcer
  • risk of severe local haemorrhage, e.g. in case of translumbar aortography
  • recent trauma and cardiopulmonary resuscitation
  • invasive operations, e.g. recent intubation
  • puncture of non-compressible vessels, intramuscular injections, large arteries
  • recent abortion or delivery
  • diseases of the urogenital tract with existing or potential sources of bleeding (implanted bladder catheter)
  • known septic thrombotic disease
  • severe arteriosclerotic vessel degeneration, cerebrovascular diseases
  • cavernous pulmonary diseases, e.g. open tuberculosis or severe bronchitis mitral valve defects or atrial fibrilation
  • aortic dissection
  • -diabetic retinopathy increase risk of local bleeding

• Streptokinase treatment administered more than 5 days and less than 12 months after the initial treatment may be ineffective. This is because antistreptokinase antibodies increase the likelihood of resistance.

   

   

• A drop in blood pressure, tachycardia or bradycardia (in some cases going as far as shock) are common at the start of therapy. As a result, at the start of therapy, the infusion should be done slowly.

   

• If the patient is on active heparin, it should be neutralized before starting thrombolytic therapy with protamine sulphate. Before beginning thrombolytic therapy, the thrombin time should not be more than twice the normal control value.