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PubMed1992

Streptokinase and lifestyle outcome in survivors of myocardial infarction.

Clinical and lifestyle parameters were assessed in 145 patients who were randomised in a double blind study comparing streptokinase or placebo given within four hours of the onset of ischaemic chest pain. Sixty-six percent of patients were in paid employment at the time of their infarct and 79% returned to paid employment. Patients who received streptokinase returned to work 17 days earlier (p less than 0.05) and returned to sport and leisure activities 33 days earlier (p less than 0.05) than those who received placebo. Those who had received streptokinase also tended to leave hospital earlier (0.8 days, p = 0.07). There were no differences in angioplasty or coronary surgery rates or the incidence of reinfarction in the first year (8%). Total community costs were reduced in the patients who received thrombolytic therapy. These findings have important implications in the benefit:cost analysis of thrombolytic therapy.

Activities of Daily Living↗

PubMed2005

Effect of pretreatment antistreptokinase antibody and streptococcal infection on the efficacy and dosage of streptokinase in acute myocardial infarction.

OBJECTIVES: The objective of the study is to determine if the presence of antistreptokinase (ASK) antibody in the blood, leads to ineffective thrombolytic therapy with streptokinase (SK) in acute myocardial infarction (AMI) and to investigate if increased dose of streptokinase (2.5 million units) could improve the infarct-related artery (IRA) patency or the clinical outcome in these patients. METHODS: The study was conducted between 1994 and 2001 in 2 institutions; King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia and in Kasr El-Aini Faculty of Medicine, Cairo, Egypt. Fifty consecutive patients with acute myocardial infarction (AMI) were included in this prospective double blind, randomized study. All patients were given the allocated streptokinase dose (1.5 or 2.5 million units) and underwent angiography within 24 hours to establish the anatomy of coronary arteries and the patency of infarct-related artery. Antistreptokinase antibody assay was carried out in a core laboratory. RESULTS: The study results showed that the presence of ASK antibody or the administration of an increased dose of SK had no effect on improving the patency rate of the infarct-related artery. CONCLUSION: The presence of a previous streptococcal infection may not necessarily reduce the effect of SK on the patency of the IRA and/or clinical outcome in patients presenting with AMI. The administration of a larger than currently recommended dose of SK (2.5 million units) did not alter the clinical outcome because it did not improve the patency rate of the IRA. However, a larger study is needed to confirm these observations.

Antibodies, Bacterial↗

PubMedDate not supplied

[Chemical modification of the functional groups of streptokinase B in the water-soluble carbodiimide-nucleophile system].

Specific activity of streptokinase was decreased after incubation in the system containing I-ethyl-3(3-dimethyl aminopropyl) carbodiimide (EDC)--ethylene diamine. Under these conditions about 8 free amino groups and 38 free carboxylic groups were modified in the streptokinase molecule. The protein conformation and the state of tryptophane residues were altered. The streptokinase modified by means of EDC-ethylene diamine treatment lost its ability to form a stable complex with human plasminogen.

Chromatography, Liquid↗

PubMed1991

Median and ulnar neuropathy after streptokinase infusion.

In a patient treated with intravenous streptokinase, inflammation developed at the infusion site followed by permanent ulnar and median neuropathy. Although adverse streptokinase infusion site reactions have been reported to the Food and Drug Administration, no other cases have been reported in the medical literature. We suggest that extravasated streptokinase may produce permanent ulnar and median neuropathy.

Aged↗

PubMed1990

Application of streptokinase in peripheral vascular thromboembolism.

To assess the efficacy of and the complications associated with streptokinase in clinical use, we administered this drug prospectively to 9 patients with thromboembolism of the peripheral vessels from August 1984 to January 1987. The involved vessels included the renal artery, superior mesenteric artery and vessels of the lower extremities. During the course of treatment, thrombin time (TT), prothrombin time (PT), and partial thromboplastin time (PTT) were monitored regularly. Complications such as fever, chills, liver function abnormalities and hematuria were managed effectively. One patient experienced anaphylactic shock and required immediate discontinuation of streptokinase. Good results were obtained in all other patients. According to the results of our study, streptokinase offers the advantages of rapid lysis and complete resolution of clots in peripheral thromboembolic disease. The complications can be minimized if clinical and laboratory responses are monitored appropriately and patients are carefully selected.

Anaphylaxis↗

PubMed1990

A collaborative study to establish the second international standard for streptokinase.

An International Standard for Streptokinase--Streptodornase (62/7) has been used to calibrate high purity clinical batches of SK since 1965. An international collaborative study, involving six laboratories, was undertaken to replace this standard with a high purity standard for SK. Two candidate preparations (88/826 and 88/824) were compared by a clot lysis assay with the current standard (62/7). Potencies of 671 i.u. and 461 i.u. were established for preparations A (88/826) and B (88/824), respectively. Either preparation appeared suitable to serve as a standard for SK. However, each ampoule of preparation A (88/826) contains a more appropriate amount of SK activity for potency testing, and is therefore preferred. Accelerated degradation tests indicate that preparation A (88/826) is very stable. The high purity streptokinase preparation, coded 88/826, has been established by the World Health Organisation as the 2nd International Standard for Streptokinase, with an assigned potency of 700 i.u. per ampoule.

Drug Stability↗

PubMed1990

[Intravenous treatment with streptokinase of acute myocardial infarction. II. Effect of patency of the artery supplying the infarction area on the infarction size and post-infarction impairement of left-ventricular function].

153 patients with a first acute myocardial infarction underwent the study. 90 of them received 1.000.000 units of streptokinase intravenously, followed by intravenous heparin administration for 5-7 days. The control group consisted of 63 remaining. In all patients serum CK-MB activity was determined every 4 hours for 72 hours: the infarct mass was calculated from the obtained curves. In 118 patients selective coronarography and left ventriculography was performed in the 2-nd or 3-rd week of hospitalisation. Left ventricular ejection fraction (E.F.) and dyssynergy index were calculated from ventriculographic data. Coronarography revealed a patent infarct-related artery in 76.7% of patients treated with streptokinase and in 44.4% of the control group (p less than 0.001). Among patients with a patent infarct-related artery an early peak of serum CK-MB activity (suggesting early recanalisation) occurred in 72.2% of streptokinase patients but in only 42.1% of the control group. Patients with a patent infarct-related artery had a significantly lower infarct mass (45 +/- 28 g vs 56 +/- 30 g), a lower left ventricular dyssynergy index (229 +/- 243 vs 348 +/- 247) and a significantly higher E.F. (63 +/- 12% vs 54 +/- 15%) compared with patients with an occluded artery.

Cardiomyopathy, Dilated↗

PubMed1990

[Intravenous systemic thrombolysis using streptokinase in the treatment of developing cardiogenic shock in myocardial infarct].

The author evaluated retrospectively the therapeutic effect of intravenous systemic thrombolysis by streptokinase in 24 patients with developing cardiogenic shock associated with myocardial infarction. Fourteen patients died while in hospital (58%) and 10 (42%) survived and were discharged after a suitable time in hospital. Serious arrhythmias were frequent already before thrombolysis (ventricular fibrillation 2X, AV block grade II and III 5X, atrial fibrillation 4X). After streptokinase administration in two patients ventricular tachycardia was recorded, twice significant ventricular extrasystoles and once AV block grade II. In none of the patients arrhythmia was the cause of death. No allergic reaction was recorded. One patient following cardiopulmonary resuscitation developed after thrombolysis haemorrhage into the chest wall from the site of injection into the subclavian vein, without further sequelae. Thirteen of the dead were subjected to necropsy which confirmed the clinical diagnosis: once a haemorrhagic infarction was found, once rupture of the heart with tamponade. In two instances coronary thrombosis was detected. Of the 10 discharged patients at the end of 1988 seven patients survived for a period of 1-8 years. From the described group it may be concluded that systemic thrombolysis in patients with developing cardiogenic shock associated with myocardial infarction is not associated with a higher incidence of side-effects and that in some of the patients with a very adverse prognosis, after streptokinase administration a change in the course of the disease occurred leading to improvement of the condition and discharge from hospital.

Aged↗

PubMed1990

[Evaluation of clinical heart insufficiency in patients with acute myocardial infarct treated with intravenous streptokinase].

We assessed the incidence of clinical heart failure in patients with acute myocardial infarction admitted to a coronary care unit and treated with intravenous streptokinase. We compared 2 groups of patients: 1) treated group: patients with acute myocardial infarction admitted to the unit in the last 3 years and treated with intravenous streptokinase, following a protocol established previously. 2) CONTROL GROUP: patients with the same characteristics and selection criteria as for the treated group, admitted to the unit during the previous 2 years and conventionally treated, without thrombolytic therapy. We assessed, in both groups, the incidence of heart failure at the time of admission, at discharge and the total incidence in the unit, following the Killip and Kimball criteria. The total incidence of heart failure was higher in the control group than in the treated group (43.8 vs 19.1%, p less than 0.001). This difference was even greater when the comparison was made with the reperfused patients (43.8% vs 18%, p less than 0.001). Heart failure incidence at the time the patients were discharged from de unit was also higher in the control group (21.2% vs 4.3%, p less than 0.001). When we considered severe heart failure (III-IV Killip Group) we also observed a significant difference between both groups. In conclusion, the incidence and the severity of clinical heart failure were lower in patients treated with streptokinase than in those treated conventionally.

Cardiac Output, Low↗

PubMed1989

Fibrinolytic profiles in local low-dose thrombolysis with streptokinase and recombinant tissue plasminogen activator.

Fibrinolytic parameters have been monitored in 44 patients undergoing local low-dose intra-arterial thrombolysis for acute peripheral arterial ischaemia. Streptokinase (Sk), at a dose of 5,000 units/hr with 250 units/hr heparin, was used in 23 patients and recombinant tissue plasminogen activator (r-tPA) at a dose of 0.5 mg/hr was used in 21 patients. Successful lysis was seen in 18 (86%) patients following r-tPA and in 15 (65%) patients following streptokinase. There were 4 minor haematomas in each group usually at the catheter entry site. Both agents produced a systemic effect, which was still seen 12 hours post-infusion. However, that produced by r-tPA was delayed and significantly reduced compared to that produced by Sk. These results confirm the relative fibrin specificity of r-tPA. When used as a continuous low-dose intra-arterial infusion, r-tPA offers a significantly lower, potentially safer, systemic effect than conventional therapy with streptokinase.

Fibrin Fibrinogen Degradation Products↗

PubMed1989

[Streptokinase therapy in a patient with lupus anticoagulant and thrombosis of the A. iliaca externa].

We report on a 26-year-old male who suffered from thrombocytopenia, factor V-deficiency and punctuate hemorrhages during the past. On admission the patient presented with acute left iliac artery occlusion. The walking distance was reduced to 200 m. Laboratory findings showed the existence of a lupus anticoagulant (LAC). As a therapeutical attempt a systemic lysis with high doses of streptokinase (9,250,000 I.E.) was carried out which was followed by a successful catheter lysis (250,000 I.E. streptokinase). During lysis the patient didn't show any unusual hemorrhagic events. Arterial thrombosis together with a lupus anticoagulant can be treated with high doses of streptokinase.

Adult↗

PubMed1989

Intravenous streptokinase therapy for acute myocardial infarction in a community hospital: effect on ventricular function and mortality.

Streptokinase can dramatically impact upon management of myocardial infarctions in community hospitals. When given by experienced personnel during the first six hours after onset of symptoms, streptokinase is associated with a high patency rate, improved left ventricular function, and reduced mortality. Careful screening of patients results in a low complication rate with infrequent serious bleeding. Streptokinase should be utilized in those hospitals without cardiac catheterization facilities, but in light of the relatively high incidence of recurrent pain (15.8%), transfer of stable patients to a facility with a catheterization laboratory should be carried out within 24 to 72 hours. As approximately 60% of patients will require PTCA, CABG, or both, diagnostic cardiac catheterization should be considered in all patients unless there are other mitigating factors.

Acute Disease↗

PubMed1989

[Long-term follow-up of acute myocardial infarction after early intravenous streptokinase].

In a series of 30 patients with acute myocardial infarction (AMI) intravenous streptokinase was given within 4 hours of the onset of chest pain. Cardiac catheterization and angiography were performed on the 6th day, and again 4 months after the acute episode. Residual coronary artery stenosis increased significantly (from 84 +/- 3% to 95 +/- 7%, p less than 0.05) in those who had stenosis of more than 80% in infarct-related arteries. In this subgroup, a higher incidence of complete occlusion was found at the second investigation than in the other patients (p less than 0.002). Those who had received early treatment with streptokinase or had residual stenosis of less than 75% showed improvement in regional function of the infarct area, confirmed at the second angiography. End-systolic volume, regarded as a sensitive prognostic marker after myocardial infarction, correlated at the second investigation with residual coronary artery stenosis determined on day 6 (p less than 0.0016). Significant improvement in global ventricular function and return of regional function to normal was found in those who had received streptokinase within 2 hours of onset of pain, and in whom residual coronary artery stenosis was less than 75%. Early fibrinolytic treatment at the time of infarction is crucial for preservation of ventricular function and its later restoration. Coronary angiography 1 week after infarction detects high-risk patients who need early revascularization.

Acute Disease↗

PubMed1986

[Intracoronary thrombolysis or brief intravenous infusion of high-dose streptokinase in the treatment of acute myocardial infarction].

Intracoronary infusions of streptokinase result in recanalization in about 80% of patients treated during the 4 hours following the first symptoms of myocardial infarction. With short, high dose intravenous infusions (streptokinase 1,500,000 units in 30 min) the recanalization rate is of the order of 60-75%. The high dose of streptokinase is well tolerated, and the intravenous infusion presents the advantage of shortening by about 2 hours the delay required to start intracoronary administration.

Animals↗

PubMedDate not supplied

[Importance of the early intravenous administration of streptokinase in acute myocardial infarct].

To evaluate the importance of early initiation of fibrinolytic therapy with intravenous streptokinase (IVSK), we studied 34 consecutive patients, within less than six hours of the onset of acute myocardial infarction, who were treated with 1.5 million units of intravenous streptokinase. All the patients had coronary angiograms in the first seventy two hours. We correlated the angiograms with the time of onset of the IVSK. The patients were divided into 3 groups: Group num. 1: From zero to two hours (twelve patients); Group num. 2: From two to four hours (13 patients); and Group num. 3: From four to six hours (nine patients). We had angiographic reperfusion in twenty-four patients (70.2%) P less than 0.05. We observed reopening in the patients of group num. 1 (83.3%); in group 2, nine patients (69%) and in group num. 3, five patients, (55.5%), with statistical significance only in group num. 1 (p less than 0.05). We also demonstrated the utility of the electrocardiographic and enzymatic criteria to predict reperfusion. No mortality was related to the procedure. We concluded that a higher percentage of reperfusion is obtained the sooner intravenous streptokinase therapy is initiated.

Coronary Circulation↗

PubMed1988

Coronary thrombolysis with intravenous streptokinase in the anesthetized dog: a dose-response study.

In order to study the in vivo coronary thrombolytic dose-response effectiveness of i.v. streptokinase, pentobarbital-anesthetized, open chest dogs were instrumented for the measurement of lead II ECG, systemic arterial blood pressure, left ventricular developed pressure, left ventricular end-diastolic pressure, left ventricular dP/dt and left anterior descending (LAD) coronary artery blood flow. In some animals, two pairs of ultrasonic dimension gauges were positioned in 1) an area of the left ventricle which would become ischemic after thrombotic occlusion of the LAD and 2) a reference area which would remain unaffected by LAD occlusion. After making an occlusive thrombus by injecting thrombin (50-200 U) and calcium chloride (50-100 mumols) into a cannulated and mechanically occluded side-branch of an isolated segment of the mid- to distal LAD, animals were given either streptokinase (5,000, 10,000, 20,000 or 40,000 U of bolus, followed by 500, 1000, 2000 or 4000 U/min of infusion, respectively) or saline, i.v. At the termination of the experiment, thrombus wet weight and, in some animals, infarct size (measured by tetrazolium staining) were determined. In control animals, thrombus wet weight was 26.7 +/- 5.4 mg (n = 8) and infarct size, as a percentage of the total left ventricle, was 30.1 +/- 4.7% (n = 6). Spontaneous reperfusion (return of LAD blood flow) was not observed in control animals that received saline. Intravenous administration of streptokinase produced a dose-dependent increase in the percentage of animals reperfusing, and a dose-dependent decrease in both thrombus wet weight and the time to reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗

PubMedDate not supplied

The use of intravenous streptokinase in a rural community hospital.

To determine the safety and efficacy of the use of intravenous streptokinase in a 110-bed rural community hospital, we studied 28 consecutive patients with clinical and ECG evidence of acute myocardial infarction. Twenty (74 percent) of the 27 patients who had cardiac catheterization after treatment with intravenous streptokinase were found to have a patent artery supplying the infarcted area. One patient (3.5 percent) died of intractable heart failure, 2 (7 percent) had ventricular fibrillation, and 9 (32 percent) had ventricular tachycardia. Six patients (21 percent) had minor bleeding problems, and 1 developed a pseudoaneurysm at the catheterization site. We maintained close communication with a consulting cardiology group who provided additional medical or surgical therapy in a tertiary medical center for patients who needed it. We believe that intravenous streptokinase can be safely and effectively used in a rural community hospital.

Adult↗

PubMed1986

Eligibility for streptokinase thrombolysis during evolving acute myocardial infarction. An historical cohort study.

To determine the percentage of acute myocardial infarction patients suitable for streptokinase thrombolysis, the charts of 990 patients from four separate hospitals with a discharge diagnosis of acute myocardial infarction were studied. In all, 750 were confirmed to actually have suffered acute myocardial infarction by enzyme and electrocardiogram criteria. Of these, 233 (31 percent of all patients with acute myocardial infarction) were judged to be suitable streptokinase candidates by virtue of being 75 years of age or younger, showing evidence of acute transmural infarction, having no contraindications to anticoagulation, and presenting to the Emergency Room within six hours or less after onset of chest pain. It is concluded that approximately one-third of all acute myocardial infarction patients in this population were eligible for streptokinase thrombolysis and that there is therefore a significant continuing role for traditional acute myocardial infarction management.

Electrocardiography↗