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PubMed1996

Jaundice induced by streptokinase.

Streptokinase is the mainstream therapy for acute myocardial infarction. A fifty-seven-year-old man with acute MI was admitted to the intensive cardiac care unit and received streptokinase and heparin. At the time of admission, he was not receiving any drugs and denied any previous exposure to a hepatotoxic agent. Five hours later he developed a dramatic hypersensitivity reaction including high fever, pulmonary edema, cyanosis, and convulsions. Within twelve hours, his clinical state was stabilized. After forty-eight hours, he developed jaundice and transaminasemia, which subsided by the eighth day. Only a few reports of overt jaundice are associated with streptokinase.

Anticoagulants↗
PubMed1983

Intravenous streptokinase in acute myocardial infarction.

Intracoronary streptokinase has been reported to be successful in producing coronary recanalization and lowered morbidity and mortality in acute myocardial infarction patients, when administered shortly after the onset of chest pain. However, intracoronary administration of streptokinase is not practical for most hospitals at present, and intravenous administration would enable treatment of larger numbers of patients and enable the drug to be administered earlier than by the intracoronary route. Available studies have suggested benefits of the intravenous route and results of randomized clinical trials indicate an approximately 20-percent decrease in mortality after intravenous use. Intravenous streptokinase after acute myocardial infarction warrants further investigation.

Humans↗
PubMed1999

Intrapleural streptokinase in the management of malignant multiloculated pleural effusions.

OBJECTIVE: Pleural effusions are a frequent complication of malignancy and cause considerable morbidity from dyspnea. The drainage and control of malignant effusions relieve symptoms and maintain quality of life but these are difficult in patients with multiloculated effusions in whom drainage usually fails. This observational series reports the use of intrapleural streptokinase (IPSK) in the management of malignant multiloculated pleural effusions resistant to standard chest tube drainage. METHODS: Ten consecutive patients with malignant multiloculated pleural effusions, aged 39 to 89 years, were given 250,000-IU doses of IPSK twice daily after failure to drain the effusions with a standard chest tube because of multiloculation and multiseptation, as demonstrated by CT or ultrasound scanning. Outcome was assessed by radiographic improvement and symptom control. RESULTS: All 10 patients responded to between 500,000 and 1,500,000 IU of streptokinase. There was an increase in pleural fluid drained (mean volume+/-SD; pre-IPSK, 843+/-690 mL; post-IPSK, 2,368+/-1,051 mL; p < 0.001, paired t test), and radiographic improvement was seen in all 10 patients. All subjects tolerated the instillation of streptokinase well. One subject required opiate analgesia for transient chest pain, and there were no hemorrhagic or allergic complications. One patient died of unrelated septicemia. CONCLUSIONS: This series suggests that IPSK may be useful in the drainage of malignant multiloculated pleural effusions in patients who fail to drain adequately with a standard chest tube. Malignant pleural effusions should not be considered a contraindication to IPSK.

Adult↗
PubMed2005

Study of warm ischemia followed by reperfusion on a lower limb model in rats: effect of allopurinol and streptokinase.

UNLABELLED: Prolonged tissue ischemia leads to changes in microcirculation and production of oxygen free radicals. The event eventually responsible for tissue death is the no-reflow phenomenon and its management is a challenge for the surgeon dealing with replantation or transplantation. We introduce a model of warm ischemia and reperfusion of the lower limb of rats with which we studied the effect of allopurinol and streptokinase. METHOD: Section of the lower limb with preservation of vessels and nerves was performed in 110 rats. Femoral vessels clamped for periods of 0, 2, 4, 6, and 8 hours of ischemia were allowed to reperfuse (groups M0, M2, M4, M6, and M8 respectively). Other groups, E1, E2, and E3, received streptokinase, allopurinol, or a combination of the two drugs after 6 hours of ischemia. RESULTS: Viability rates of the ischemic limbs after 7 days were 100% (M0), 80% (M2), 63.6% (M4), 50% (M6), and 20% (M8). In the experimental groups, E1, E2, and E3, viability rates were 67% (E1), 70% (E2), and 70% (E3). Groups M0, M2, M4, M6, and M8 differed among themselves except for groups M4 and M6. Group E1 had a higher rate of limb viability than M6 (control group) but not than M4. Groups E1, E2 and E3 had higher rates of limb viability than M6 but not than M2 or M4. DISCUSSION: The results suggest that increased viability of limbs after 6 hours of ischemia occurs when allopurinol or streptokinase is used. The combination of the two drugs does not appear to produce any additional effect.

Allopurinol↗
PubMed1982

Contrast extravasation through Dacron grafts: a sequela of low-dose streptokinase therapy.

Local transcatheter administration of low-dose streptokinase for the treatment of thrombosed Dacron grafts was performed in four patients. Angiography after the infusion revealed extravasation of contrast material through the interstices of the graft. In each case the graft material was knitted Dacron, Surgically placed 1 month to 6 years before infusion with streptokinase. The fibrinolytic activity of streptokinase is likely responsible for lysis of the fibrin in the interstices of the graft with resultant extravasation of contrast material.

Aged↗
PubMed1987

Intraarterial fibrinolytic therapy for popliteal and tibial artery obstruction: comparison of streptokinase and urokinase.

Experience with using intraarterial fibrinolysis in the treatment of occlusive disease of the popliteal artery and runoff vessels is limited. We describe the techniques and results in 25 patients with 30 fibrinolytic infusions of the popliteal and tibial arteries and compare them with the initial and long-term results of treatment using streptokinase and urokinase. The roles of catheter delivery systems and systemic heparin in the prevention of pericatheter thrombus were also studied. Urokinase was initially successful in 18 (90%) of 20 intraarterial infusions, whereas streptokinase was effective in 8 (80%) of 10 intraarterial infusions. Urokinase had the advantages of a shorter effective infusion time and fewer complications. Long-term follow-up was available in 20 of the successfully treated patients. Sixteen of these patients were doing well with an average follow-up of 27 months. The duration of the initial occlusion may be useful in identifying patients at risk for early reocclusion. No limbs were lost because of complications of therapy. The coaxial catheter system with a divided fibrinolytic dose provided protection against pericatheter thrombus, while systemic heparin was ineffective. Our results suggest that urokinase is more effective than streptokinase for intraarterial infusion in the treatment of occlusion of the popliteal and tibial arteries; this procedure is an important alternative to surgery or an adjuvant to surgery in selected patients.

Arterial Occlusive Diseases↗
PubMed1989

Thrombolysis using liposomal-encapsulated streptokinase: an in vitro study.

The clot-lysing ability of streptokinase (SK) was examined using membrane-bound thrombi. Encapsulation of SK in large unilamellar phospholipid vesicles (liposomes) resulted in entrapping approximately 30% of its original activity. Measurements of streptokinase activity for liposomal-encapsulated streptokinase (LESK) indicated little loss of activity or leakage in Tris-buffered saline over a 24-hr period at temperatures of 4 and 23 degrees C. However, incubation of free SK and LESK in platelet-poor plasma (PPP) at 37 degrees C resulted in a decrease of SK activity. The retention of SK activity in LESK was considerably higher than that of unentrapped SK. Clot-dissolving time (CDT) was measured by monitoring the pressure drop during slow filtration in plasma through membrane-bound thrombi. The results indicated that both LESK and free SK were able to activate the fibrinolytic system. Without prior incubation in PPP at 37 degrees C, the CDT of a SK and PPP mixture (SK/PPP) was 10.7 +/- 1.9 min (n = 12), while that of a LESK and PPP mixture (LESK/PPP) was 12.4 +/- 1.7 min (n = 12). The CDT-detected clot-lysing abilities of both SK and LESK were diminished by incubation in PPP, but to different extents. After 15- and 30-min incubations, the CDT of SK/PPP increased significantly to 15.5 +/- 1.5 and 24.1 +/- 2.4 min (n = 5, P less than 0.05), respectively. In contrast, the CDT of LESK/PPP increased to 13.3 +/- 0.8 min (n = 5) after 15 min of incubation and to 16.0 +/- 1.1 min (n = 5, P less than 0.05) after a 30-min incubation. These results suggest that entrapment of SK in liposomes preserves the thrombolytic potential of the plasminogen activator by limiting its exposure to the components of the plasma.

Adult↗
PubMed1990

Coronary thrombolysis: streptokinase or recombinant tissue-type plasminogen activator?

In patients with acute myocardial infarction, intravenous streptokinase therapy recanalizes 40% to 45% of occluded coronary arteries and reduces mortality by 25%. Recombinant tissue-type plasminogen activator (rt-PA) therapy is more potent for coronary arterial thrombolysis, producing both more rapid and more frequent (65% to 70%) reperfusion. Side effects (mainly reocclusion and bleeding) of streptokinase and rt-PA therapy are not markedly different. Whether the higher efficacy of rt-PA therapy will translate into a comparably larger reduction of morbidity and mortality remains to be determined in large comparative clinical trials. Both agents are available for clinical use. At present, the choice of agent for treating acute myocardial infarction must be based on consideration of the lower cost of streptokinase therapy compared with the established higher efficacy of rt-PA therapy for coronary recanalization.

Clinical Trials as Topic↗
PubMed1999

[Intrapleural fibrinolysis with streptokinase in th treatment of loculated empyema].

Intrapleural fibrinolytic treatment is increasingly used in patients with loculated empyema. In this paper, we report our experience with fibrinolytic therapy in eight patients with empyema not responding to drainage and antibiotics. Mean patient age was 47 (range 3-76), and mean duration of symptoms 14 weeks (range 1-24). The patients were treated with 250,000 IU streptokinase in four hours, 1-6 intrapleural instillations (except 50,000 IU for the child). Between 500 and 4,500 cc fluid was drained. Mean drainage time was 14 days (range 6-20). Mean time spent in hospital was 20 days (range 15-25). No microbiological agent was isolated in three patients. All patients recovered. One patient experienced a hypersensitivity reaction following streptokinase treatment for more than one week. Fibrinolysis with streptokinase should be used in patients with loculated empyema when drainage and antibiotics fail.

Adolescent↗
PubMed1999

[Streptokinase-induced jaundice].

Streptokinase is a thrombolytic agent used very frequently for the early treatment of acute myocardial infarction. A 35-year-old male with inferior acute myocardial infarction was admitted to the Coronary Care Unit and treated with systemic streptokinase. At the time of admission, he was a healthy male and he was not receiving any hepatotoxic agent. Six hours after thrombolysis, he developed high fever, painful hepatomegaly, jaundice and coluric urine. Leucocytosis with left deviation was observed in the hemogram and the liver function tests showed slight enzymatic elevation and hyperbilirubinemia. This condition was progressively improving and the patient was free of symptoms on the eighth day of evolution. Jaundice as secondary effect of streptokinase has been previously communicated in very few medical reports.

Adult↗
PubMedDate not supplied

Megadose heparin and streptokinase produce similar TIMI 3 flow at discharge in patients of acute myocardial infarction presenting between 7-12 hours.

The present study was undertaken to assess the impact of megadose heparin bolus on angiographic patency of infarct-related artery in patients of acute myocardial infarction presenting between 7-12 hours and to compare it with streptokinase. Forty-seven patients (27 males, mean age 58.1 +/- 9.6 years) of acute myocardial infarction between 7-12 hours of onset of chest pain were randomised to receive either megadose heparin bolus (300 IU/kg body weight, group 1, n = 24; or streptokinase 1.5 million units over one hour, group 2, n = 23). Parameters noted were: relief of pain at 90 minutes, 50 percent or more resolution of ST segment at 90 minutes, TIMI grade flow and left ventricular ejection fraction at discharge. Mean age (59.0 +/- 12.9 years in group 1; 57.2 +/- 8.1 years in group 2), mean time to drug (7.5 +/- 1.3 hours in group 1; 7.8 +/- 1.6 hours in group 2), site of anterior wall infarction (12 in group 1, 10 in group 2), relief of pain at 90 minutes (15 in group 1, 14 in group 2) and more than 50 percent resolution of ST segment elevation at 90 minutes (12 patients in each group) were similar. On coronary angiography performed in 42 patients (21 in each group) at a mean interval of 7.2 +/- 1.3 days after acute myocardial infarction, TIMI grade 3 flow was seen in 7 (33.3%) patients in each group and TIMI grade 2/3 flow was also similar in both the groups (p = NS). No major bleed occurred in either group. We conclude that heparin given as a megadose bolus produces similar TIMI 3 flow in infarct-related artery as compared to streptokinase in acute myocardial infarction patients presenting between 7-12 hours.

Aged↗
PubMed1999

[Circadian fluctuations in the success and efficacy of streptokinase thrombolytic therapy in acute myocardial infarction].

This study was designed to assess possible diurnal fluctuations in the efficacy of thrombolysis with streptokinase. 156 consecutive patients treated with streptokinase during the period 1.1.95-1.7.96 were studied retrospectively. Success or failure of thrombolysis was determined according to the accepted clinical and angiographic criteria starting at midnight, 12 times at 2-hour intervals, then 8 times at 3-hour intervals, and then 6 times at 4-hour intervals. A definite peak for successful thrombolysis was found in the late afternoon and early evening hours. Between 16:00-20:00 PM, in 30.23% successful thrombolysis were observed, compared to 6.98% between 20:00-24:00 PM (p < 0.05) and in 10.53% between 00.00-04:00 AM (p < 0.05). Multiple regression analysis showed that the independent factor with the greatest impact on successful reperfusion was the actual time until thrombolysis (p = 0.037); then came the interval from pain onset to streptokinase administration (p = 0.020), while age and gender had much lesser impacts (p = 0.328 and 0.215, respectively), and individual risk factors even less. These findings may have several clinical implications: dose adjustment for the time of day may be required, with larger doses needed during morning hours, or preference for primary coronary angioplasty to avoid increase in bleeding complications due to higher doses of thrombolytic agents.

Adult↗
PubMedDate not supplied

Intrapleural streptokinase in a two-year-old child with a parapneumonic effusion.

A two-year-old child was hospitalised with features of parapneumonic effusion. He was initially managed with parenteral antibiotics and chest tube drainage. After three days drainage became insignificant inspite of chest tube being patent and appropriately positioned. CT scan of chest showed multiloculated effusion. In view of multiloculated effusion it was decided to try intrapleural fibrinolysis with streptokinase. Streptokinase in a dose of 1,25000 IU dissolved in 50 ml of normal saline was instilled through the chest tube daily. After instilling three doses, there was a significant increase in the drainage followed by almost complete radiological resolution. There were no side effects. Intrapleural streptokinase is a useful adjunctive threapeutic modality in the management of complicated parapneumonic effusion or empyema in paediatric patients.

Chest Tubes↗
PubMed2003

Diffuse alveolar hemorrhages and hemorrhagic pleural effusion after thrombolytic therapy with streptokinase for acute myocardial infarction.

Thrombolytic therapy with streptokinase is commonly used in acute myocardial infarction and has markedly reduced morbidity and mortality from this condition. However, it can cause various hemorrhagic and immunological complications. We report a patient who developed diffuse pulmonary hemorrhages and bilateral hemorrhagic pleural effusion after thrombolytic therapy with streptokinase for acute myocardial infarction. This was recognized by a drop of hematocrit, pulmonary infiltrates, hemorrhagic pleural effusion and hypoxemia. The diagnosis was confirmed by demonstration of iron-laden macrophages (siderophages) in bronchoalveolar lavage. The patient required mechanical ventilation and recovered successfully. This combination of pulmonary hemorrhages and hemorrhagic pleural effusion following streptokinase therapy is extremely unusual and has not been reported previously.

Adult↗
PubMed1976

Criteria for successful thrombolysis by streptokinase.

Streptokinase treatment of deep vein thrombosis is reviewed, with emphasis on the mechanism of action of streptokinase, the bleeding caused by this agent, and incomplete thrombolysis. Criteria for successful thrombolysis and the advantages of intermittent streptokinase therapy to overcome the problems of bleeding and incomplete thrombolysis are discussed.

Drug Administration Schedule↗
PubMed1992

[Early and late results of myocardial revascularization after coronary thrombolysis with intravenous streptokinase in the treatment of acute myocardial infarction].

PURPOSE: To study the early and late results of patients treated initially intravenous streptokinase and then with coronary artery bypass surgery. METHODS: One hundred and twenty one patients with acute myocardial infarction less than 6 hours duration were treated initially with intravenous streptokinase, and 1-38 days after (median 8.80 days) coronary artery bypass was undertaken. Ninety six patients were operated with extracorporeal circulation and 25 without it. RESULTS: Overall operative mortality was 3.30% (4/121). Reoperations due to bleeding was necessary in 3.30% (4/121). Late mortality was 5.40% with survival probability of 94.60% after 36 months and 92.30% after 70 months. Late morbidity events in terms of angina and cardiac insufficiency demonstrated that 7 patients had angina, 4 cardiac insufficiency and two angina and cardiac insufficiency; probability to be free from these events was 88.20% after 46 months and 66.40% after 70 months. CONCLUSION: Coronary artery bypass surgery after intravenous streptokinase can be undertaken with security and excellent early and late results.

Adult↗
PubMed1992

[Henoch-Schönlein purpura following treatment with streptokinase].

This article presents the clinical history of a man aged 64 who developed Henoch-Schönlein purpura after administration of streptokinase for acute myocardial infarction. Because of the increasing use of streptokinase it is assumed that type III hypersensitivity reactions to streptokinase will be seen more frequently. The first symptoms may arise after discharge from the hospital, as symptom-free periods of 3 to 21 days have been reported.

Humans↗
PubMed1992

[Aggressive treatment of acute pulmonary embolism. 132 consecutive patients treated with heparin, streptokinase or embolectomy, 1975-1987].

During 1975-1987, 132 patients were treated for acute pulmonary embolism with heparin (n = 41), streptokinase (n = 52), or embolectomy (n = 39). In 1984, the indications for embolectomy were broadened to include all patients with central emboli, also those who were circulatory stable. The heparin-, streptokinase-, and embolectomy groups differed from each other as regards the degree of circulatory impairment (stable circulation/reversible shock/circulatory collapse: 68/32/0% versus 52/48/0% versus 16/56/28%, p less than 0.0001) and embolic score (20 for complete obstruction; 5.6 +/- 3.4 versus 8.7 +/- 2.8 versus 13.2 +/- 2.4, p less than 0.0001), but were comparable in terms of prognosis (30-day mortality/10-year survival +/- standard error: 7%/61 +/- 9% versus 13%/59 +/- 9% versus 18%/61 +/- 10%). Stable circulation, reversible shock, and circulatory collapse prior to embolectomy resulted in 30-day mortalities of 0%, 9%, and 45% respectively (p less than 0.01). During 1984-1987, no early or late deaths after embolectomy were observed in patients without circulatory collapse (n = 10). In comparable patients (embolic score greater than or equal to 9, symptom duration less than or equal to 7 days, no circulatory collapse), streptokinase treatment (n = 13) and embolectomy (n = 25) resulted in 10-year survival +/- standard error of 46 +/- 16% and 82 +/- 10% respectively (p less than 0.0001) and in an embolic score-reduction (score before minus score after treatment) of 5.7 +/- 2.3 and 10.5 +/- 2.9, respectively (p less than 0.0001). Embolectomy during extracorporeal circulation should be considered the treatment-of-choice in patients with acute central emboli.

Acute Disease↗